MEDICARE: TAMIKA COVINGTON LMSW

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	104100000X	Social Worker	106413	NY

General Provider Information

NPI Number	:	1821603820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMIKA COVINGTON LMSW

Provider Business Mailing Address
First Line	:	75 LIBERTY AVE UNIT C28
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5057
Country	:	US
Telephone Number	:	646-694-0200
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 LIBERTY AVE UNIT C28
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5057
Country	:	US
Telephone Number	:	917-805-0365
Fax Number	:

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

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	09/15/2020

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