Provider Demographics
NPI:1275823551
Name:MANCUSO, TAMARA LYNNE (PCD(DONA),CLC)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:LYNNE
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:PCD(DONA),CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 MARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-4266
Mailing Address - Country:US
Mailing Address - Phone:585-621-9049
Mailing Address - Fax:
Practice Address - Street 1:365 MARWOOD RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-4266
Practice Address - Country:US
Practice Address - Phone:585-621-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula