Provider Demographics
NPI:1184033953
Name:TORMOLLAN, MICHELE (LCSWC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:TORMOLLAN
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-0144
Mailing Address - Country:US
Mailing Address - Phone:410-399-9000
Mailing Address - Fax:
Practice Address - Street 1:260 GATEWAY DR STE 19B
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4203
Practice Address - Country:US
Practice Address - Phone:410-762-4374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19868104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker