Provider Demographics
NPI:1497796239
Name:TAMM, LINDA K (PSY D)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:TAMM
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CLYDE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3490
Mailing Address - Country:US
Mailing Address - Phone:732-873-3100
Mailing Address - Fax:732-873-3100
Practice Address - Street 1:15 CLYDE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3490
Practice Address - Country:US
Practice Address - Phone:732-873-3100
Practice Address - Fax:732-873-3100
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100392600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0104591Medicaid