MEDICARE: TAMECKA HENNINGHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	135635	CA
2	1041C0700X	Clinical Social Worker	114669	CA

General Provider Information

NPI Number	:	1528376084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMECKA HENNINGHAM

Provider Business Mailing Address
First Line	:	5601 DE SOTO AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6701
Country	:	US
Telephone Number	:	818-719-3785
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 DE SOTO AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6701
Country	:	US
Telephone Number	:	818-719-3785
Fax Number	:	818-719-3785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	12/10/2025

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Directions to “ TAMECKA HENNINGHAM ” Practice Location

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