Provider Demographics
NPI:1164554176
Name:LEOMBRUNO, TAMMY LYNN (MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:LEOMBRUNO
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HAWK RDG
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-9203
Mailing Address - Country:US
Mailing Address - Phone:802-878-4990
Mailing Address - Fax:802-878-1477
Practice Address - Street 1:25 WENTWORTH DR
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9733
Practice Address - Country:US
Practice Address - Phone:802-878-4990
Practice Address - Fax:802-878-1477
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007565Medicaid