Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Individual
MS. MARY E TYSOR-TETLEY
Active
Individual
MS. MARY E TYSOR-TETLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
T14553
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11634766
CAQH
—
Enumeration date
10/27/2005
Last updated
07/08/2007
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