Provider Demographics
NPI:1174689699
Name:TARTAMELLA, JOSEPH T (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:T
Last Name:TARTAMELLA
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 CANNADYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:KITTRELL
Mailing Address - State:NC
Mailing Address - Zip Code:27544-7700
Mailing Address - Country:US
Mailing Address - Phone:919-690-1996
Mailing Address - Fax:
Practice Address - Street 1:4028 CANNADYS MILL RD
Practice Address - Street 2:
Practice Address - City:KITTRELL
Practice Address - State:NC
Practice Address - Zip Code:27544-7700
Practice Address - Country:US
Practice Address - Phone:919-690-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0033441041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003199Medicaid
NC6003199Medicaid