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NPI Code Detail

MEDICARE: NICHOLAS TAMBORRA LMHC

MEDICARE: NICHOLAS TAMBORRA LMHC
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
1101YM0800XMental Health Counselor007887NY

General Provider Information

NPI Number : 1316465818
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS TAMBORRA LMHC
Provider Business Mailing Address
First Line : 1765 SOUTH AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-3604
Country : US
Telephone Number : 718-982-6982
Fax Number :
Provider Business Practice Location Address
First Line : 1765 SOUTH AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-3604
Country : US
Telephone Number : 718-982-6982
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2017
Last Update Date : 07/21/2022

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Directions to “ NICHOLAS TAMBORRA LMHC” Practice Location

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