Provider Demographics
NPI:1053649681
Name:FLECK, TAMERA MARTINO (LCSW)
Entity type:Individual
Prefix:
First Name:TAMERA
Middle Name:MARTINO
Last Name:FLECK
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 1:1501 SAN ELIJO RD S
Mailing Address - Street 2:#104-117
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2047
Mailing Address - Country:US
Mailing Address - Phone:760-517-6257
Mailing Address - Fax:760-593-2699
Practice Address - Street 1:1244 SAN ELIJO RD N
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1086
Practice Address - Country:US
Practice Address - Phone:760-517-6257
Practice Address - Fax:760-593-2699
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS234771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACR285ZMedicare UPIN
CAW416Medicare PIN