Provider Demographics
NPI:1992461479
Name:FOOTMAN, TANYA (LCSW)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:FOOTMAN
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 1:825 BENJAMIN CHAIRES RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-7680
Mailing Address - Country:US
Mailing Address - Phone:850-933-3644
Mailing Address - Fax:
Practice Address - Street 1:825 BENJAMIN CHAIRES RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-7680
Practice Address - Country:US
Practice Address - Phone:850-933-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW112001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical