Provider Demographics
NPI:1043693021
Name:MENDELSON, TAMAR (PHD)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:
Last Name:MENDELSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 N BROADWAY
Mailing Address - Street 2:ROOM 853
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1900
Mailing Address - Country:US
Mailing Address - Phone:410-502-6219
Mailing Address - Fax:
Practice Address - Street 1:624 N BROADWAY
Practice Address - Street 2:ROOM 853
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1900
Practice Address - Country:US
Practice Address - Phone:410-502-6219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04269103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical