Provider Demographics
NPI:1972640985
Name:TOMBROFF, TAMMY L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:L
Last Name:TOMBROFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TAMMY
Other - Middle Name:L
Other - Last Name:TOMBROFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3013 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084
Mailing Address - Country:US
Mailing Address - Phone:904-829-3097
Mailing Address - Fax:
Practice Address - Street 1:3013 1ST ST
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2268
Practice Address - Country:US
Practice Address - Phone:904-321-6049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW72181041C0700X
FL72181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11359410OtherCAQH
FL270801OtherCOMPSYCH
FL2273051OtherFIRST HEALTH CNN
FLZ072GOtherBCBS
FL11359410OtherCAQH