Provider Demographics
NPI:1386352094
Name:AUDET, TIANNA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:TIANNA
Middle Name:MARIE
Last Name:AUDET
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 BELLE CHASE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-4257
Mailing Address - Country:US
Mailing Address - Phone:813-503-9783
Mailing Address - Fax:
Practice Address - Street 1:710 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4938
Practice Address - Country:US
Practice Address - Phone:813-503-9783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW188341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical