Healthcare Provider Details

I. General information

NPI: 1922166792
Provider Name (Legal Business Name): PATRICIA ANN TADEMY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5503 CANYON BLUFF CT
ROSHARON TX
77583-2090
US

IV. Provider business mailing address

5503 CANYON BLUFF CT
ROSHARON TX
77583-2090
US

V. Phone/Fax

Practice location:
  • Phone: 832-891-9355
  • Fax:
Mailing address:
  • Phone: 832-891-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20106
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: