Provider Demographics
NPI:1124075395
Name:NEMTZOW, TEMA CYNTHIA (MSW)
Entity type:Individual
Prefix:
First Name:TEMA
Middle Name:CYNTHIA
Last Name:NEMTZOW
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BRITTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-3418
Mailing Address - Country:US
Mailing Address - Phone:203-330-0530
Mailing Address - Fax:401-941-7333
Practice Address - Street 1:120 BRITTON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-3418
Practice Address - Country:US
Practice Address - Phone:203-330-0530
Practice Address - Fax:401-941-7333
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT0028201041C0700X
RIISW006211041C0700X
MA10158661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI809025049Medicare ID - Type Unspecified
MAP04641Medicare ID - Type Unspecified