Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 127236121 | WI |
Y | 1041C0700X | Clinical Social Worker | 7843-123 | WI |
NPI | 1003121211 |
---|---|
Provider Name | Tanya Desarmo |
First Address | Sheboygan, WI 53081-8914 |
Second Address | Sheboygan, WI 53081-8914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2010 |
Last Update Date | 03/12/2012 |