Provider Demographics
NPI:1144994237
Name:STAVERMAN, TYLER GLENN (MSW LCSW)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:GLENN
Last Name:STAVERMAN
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 HUNTSMAN TRL
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-8513
Mailing Address - Country:US
Mailing Address - Phone:919-721-3495
Mailing Address - Fax:
Practice Address - Street 1:151 N STEELE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-3966
Practice Address - Country:US
Practice Address - Phone:919-292-2614
Practice Address - Fax:919-964-3374
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0140941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical