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NPI Code Detail

MEDICARE: TISA MARIA THOMSON LCSW

MEDICARE: TISA MARIA THOMSON LCSW
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
11041C0700XClinical Social Worker15718FL

General Provider Information

NPI Number : 1548129695
Entity Type Code : Individual
Provider Name (Legal Business Name) : TISA MARIA THOMSON LCSW
Provider Business Mailing Address
First Line : 6115 SW 146TH CT
Second Line :
City : MIAMI
State : FL
Zip : 33183-1015
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4651 SALISBURY RD STE 400
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-6187
Country : US
Telephone Number : 646-941-7645
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2026
Last Update Date : 01/15/2026

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Directions to “ TISA MARIA THOMSON LCSW” Practice Location

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