Provider Demographics
NPI:1760722995
Name:BACK TAMBURO, MELISSA (PHD, LCSW-C)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:BACK TAMBURO
Suffix:
Gender:F
Credentials:PHD, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 MURDOCK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1746
Mailing Address - Country:US
Mailing Address - Phone:410-952-7683
Mailing Address - Fax:
Practice Address - Street 1:10440 SHAKER DR STE 208
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2339
Practice Address - Country:US
Practice Address - Phone:410-884-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD073141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical