Provider Demographics
NPI:1871826511
Name:TAMBORRIELLO, DOMENIC (LMSW)
Entity Type:Individual
Prefix:
First Name:DOMENIC
Middle Name:
Last Name:TAMBORRIELLO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 COLLINGWOOD ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3813
Mailing Address - Country:US
Mailing Address - Phone:734-649-7092
Mailing Address - Fax:
Practice Address - Street 1:210 COLLINGWOOD ST
Practice Address - Street 2:SUITE 120
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3813
Practice Address - Country:US
Practice Address - Phone:734-649-7092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010209731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical