Provider Demographics
NPI:1851705644
Name:TABBACHINO, ELIZABETH (LGSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:TABBACHINO
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 KEYSVILLE RD
Mailing Address - Street 2:US ROUTE 15 AND KEYSVILLE ROAD
Mailing Address - City:EMMITSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21727-8619
Mailing Address - Country:US
Mailing Address - Phone:301-447-2361
Mailing Address - Fax:301-447-3715
Practice Address - Street 1:9701 KEYSVILLE RD
Practice Address - Street 2:US ROUTE 15 AND KEYSVILLE ROAD
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727-8619
Practice Address - Country:US
Practice Address - Phone:301-447-2361
Practice Address - Fax:301-447-3715
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17339104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker