Provider Demographics
NPI:1215288030
Name:CHANDLER, TAMARIA E (MSED)
Entity type:Individual
Prefix:
First Name:TAMARIA
Middle Name:E
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 W TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-1025
Mailing Address - Country:US
Mailing Address - Phone:850-577-1780
Mailing Address - Fax:850-841-7792
Practice Address - Street 1:471 W TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1025
Practice Address - Country:US
Practice Address - Phone:850-577-1780
Practice Address - Fax:850-841-7792
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL71589104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070997200Medicaid