Basic Information
| Provider Information | |||||||||
| NPI: | 1851663322 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNG | ||||||||
| FirstName: | TAMMIE | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 STEFFEN AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452152338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135883623 | ||||||||
| FaxNumber: | 5135544115 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 MADISON RD | ||||||||
| Address2: | #3 | ||||||||
| City: | WALNUT HILLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133545200 | ||||||||
| FaxNumber: | 5133547115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2012 | ||||||||
| LastUpdateDate: | 01/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I 1500128 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | I1500128 | 01 | OH | LICENSE | OTHER |