Provider Demographics
NPI:1235311390
Name:INTSCHERT, TABITHA ANN (LCSW-C)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:ANN
Last Name:INTSCHERT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:ANN
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:5669 N ORACLE RD STE 2101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3856
Mailing Address - Country:US
Mailing Address - Phone:520-812-6565
Mailing Address - Fax:520-326-8669
Practice Address - Street 1:5669 N ORACLE RD STE 2101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3856
Practice Address - Country:US
Practice Address - Phone:520-812-6565
Practice Address - Fax:520-326-8669
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-153131041C0700X
MD155391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR968OtherCAREFIRST FEDERAL
MDLM49EAOtherCAREFIRST
MD455738OtherMHN
MD609550001Medicaid
MD609550004Medicaid
MD522156095OtherAMERICAN PSYCH SYSTEM
MD522156095OtherAMERICAN PSYCH SYSTEM