Provider Demographics
NPI:1851816987
Name:TAMBORSKI, MARY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:TAMBORSKI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9541 GROSSMONT SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-4105
Mailing Address - Country:US
Mailing Address - Phone:858-254-9378
Mailing Address - Fax:
Practice Address - Street 1:9541 GROSSMONT SUMMIT DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-4105
Practice Address - Country:US
Practice Address - Phone:858-254-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95969106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist