MEDICARE: TAMMI VAN HOLLANDER LCSW, RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical	CW013902	PA

General Provider Information

NPI Number	:	1417154485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMI VAN HOLLANDER LCSW, RPT

Provider Business Mailing Address
First Line	:	119 COULTER AVE
Second Line	:	SUITE 213
City	:	ARDMORE
State	:	PA
Zip	:	19003-2427
Country	:	US
Telephone Number	:	610-642-1144
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 COULTER AVE
Second Line	:	SUITE 213
City	:	ARDMORE
State	:	PA
Zip	:	19003-2427
Country	:	US
Telephone Number	:	610-642-1144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	07/22/2014

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