=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861980054
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOMARO'S CHANGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2018
-----------------------------------------------------
Last Update Date | 11/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3301 GREEN ST STE 235
-----------------------------------------------------
City | CLAYMONT
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-222-8500
-----------------------------------------------------
Fax | 844-222-8986
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1261 PARISH AVE
-----------------------------------------------------
City | CLAYMONT
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19703-3338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-222-8500
-----------------------------------------------------
Fax | 844-222-8986
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER - EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. TOMARO M PILGRIM
-----------------------------------------------------
Credential | MSC, MSHS, LMSW
-----------------------------------------------------
Telephone | 844-222-8500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------