Healthcare Provider Details

I. General information

NPI: 1164033080
Provider Name (Legal Business Name): TAMMY J CLEVENGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6313 CORPORATE CT STE 130
FORT MYERS FL
33919-3509
US

IV. Provider business mailing address

7590 GRADY DR
NORTH FORT MYERS FL
33917-2470
US

V. Phone/Fax

Practice location:
  • Phone: 239-362-0144
  • Fax: 239-362-0710
Mailing address:
  • Phone: 239-672-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: