Provider Demographics
NPI:1619685120
Name:TAMBURELLO, ANGELLINA DELIGHT (RBT)
Entity Type:Individual
Prefix:
First Name:ANGELLINA
Middle Name:DELIGHT
Last Name:TAMBURELLO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 FERRY ST APT 301
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-5643
Mailing Address - Country:US
Mailing Address - Phone:857-326-9843
Mailing Address - Fax:
Practice Address - Street 1:35 VILLAGE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:MA
Practice Address - Zip Code:01949-1234
Practice Address - Country:US
Practice Address - Phone:857-326-9843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA834539103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA834539Medicaid