Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 1-09-5671 | |
Y | 102L00000X | Psychologist | PY8959 | FL |
Y | 103T00000X | Psychologist | PY8959 | FL |
NPI | 1013212299 |
---|---|
Provider Name | Dr. Tamara Pawich |
First Address | Cocoa Beach, FL 32931-3273 |
Second Address | Cocoa Beach, FL 32931-5213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2011 |
Last Update Date | 27/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018109300 | (05) | FL |