Healthcare Provider Details

I. General information

NPI: 1861980054
Provider Name (Legal Business Name): TOMARO'S CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 GREEN ST STE 235
CLAYMONT DE
19703
US

IV. Provider business mailing address

1261 PARISH AVE
CLAYMONT DE
19703-3338
US

V. Phone/Fax

Practice location:
  • Phone: 844-222-8500
  • Fax: 844-222-8986
Mailing address:
  • Phone: 844-222-8500
  • Fax: 844-222-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TOMARO M PILGRIM
Title or Position: FOUNDER - EXECUTIVE DIRECTOR
Credential: MSC, MSHS, LMSW
Phone: 844-222-8500