Mary E Tysor-Tetley, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

T14553 Issued in CA

Practice address

339 Cajon St
Ste B
Redlands, CA 92373-5901

Phone

(909) 783-1078

Fax

(909) 801-8070

NPI assigned

Oct 27, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Mary Elizabeth Tysor Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477543643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 CAJON ST",
            "address_2": "STE B",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735901",
            "telephone_number": "909-783-1078",
            "fax_number": "909-801-8070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 CAJON ST",
            "address_2": "STE B",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735901",
            "telephone_number": "909-783-1078",
            "fax_number": "909-801-8070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYSOR-TETLEY",
        "first_name": "MARY",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "T14553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11634766",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "TYSOR",
            "middle_name": "ELIZABETH",
            "prefix": "MS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Craig James Turner, CRNA
• Roberta Michele Turner, MS-SLP
• Stephanie Tuttle-Kamon, NP-C, RN
• Francesca Maria Twohy-Haines, LCSW
• Andrew Tyler, PA
• Anietie Ukpe
• Kristen Elaine Ulmer, MSW, ASW
• Heather Dawn Ulrich, LCSW
• Angela Um
• Diseph Tomi Umah-Mgborogwu

• Clinical Social Worker in Redlands, CA
• Providers in Redlands, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.