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General NPI Number Information
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NPI Number | 1760722995
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Entity Type | Individual
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Provider Name | MELISSA BACK TAMBURO PHD, LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 10440 SHAKER DR STE 208
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City | COLUMBIA
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State | MD
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Zip | 21046-2339
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Country | US
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Telephone | 410-884-6031
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Fax |
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Provider Business Mailing Address
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Address Line | 83 MURDOCK RD
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City | BALTIMORE
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State | MD
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Zip | 21212-1746
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Country | US
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Telephone | 410-952-7683
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 07314
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License Number State | MD
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