Provider Demographics
NPI:1720758170
Name:RAMIREZ, TILLY HOPE (LMSW)
Entity type:Individual
Prefix:
First Name:TILLY
Middle Name:HOPE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LAKEFRONT CMNS UNIT 410
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3465
Mailing Address - Country:US
Mailing Address - Phone:631-294-9456
Mailing Address - Fax:
Practice Address - Street 1:1000 LAKEFRONT CMNS UNIT 410
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3465
Practice Address - Country:US
Practice Address - Phone:631-294-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0903004240104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program