Provider Demographics
NPI:1275052268
Name:TAMMARO, KAITLYN AMBER (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:AMBER
Last Name:TAMMARO
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:MISS
Other - First Name:KAITLYN
Other - Middle Name:A
Other - Last Name:WENZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3929 ROCKY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4153
Mailing Address - Country:US
Mailing Address - Phone:216-252-5800
Mailing Address - Fax:216-252-9055
Practice Address - Street 1:3929 ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4153
Practice Address - Country:US
Practice Address - Phone:216-252-5800
Practice Address - Fax:216-252-9055
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2203549-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical