Provider Demographics
NPI:1487026852
Name:TAMBOLI, ASHLEY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:TAMBOLI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 RAIFORD OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9507
Mailing Address - Country:US
Mailing Address - Phone:985-373-8915
Mailing Address - Fax:
Practice Address - Street 1:60 LOUIS PRIMA DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5903
Practice Address - Country:US
Practice Address - Phone:985-327-5427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker