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General NPI Number Information
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NPI Number | 1053649681
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Entity Type | Individual
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Provider Name | TAMERA MARTINO FLECK LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 1244 SAN ELIJO RD N
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City | SAN MARCOS
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State | CA
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Zip | 92078-1086
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Country | US
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Telephone | 760-517-6257
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Fax | 760-593-2699
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Provider Business Mailing Address
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Address Line | 1501 SAN ELIJO RD S #104-117
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City | SAN MARCOS
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State | CA
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Zip | 92078-2047
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Country | US
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Telephone | 760-517-6257
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Fax | 760-593-2699
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS23477
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License Number State | CA
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