Provider Demographics
NPI:1336681394
Name:TUMBARELLO, MICHAEL ANGELO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANGELO
Last Name:TUMBARELLO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2503
Mailing Address - Country:US
Mailing Address - Phone:917-497-2888
Mailing Address - Fax:
Practice Address - Street 1:492 2ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2503
Practice Address - Country:US
Practice Address - Phone:917-497-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0882881041C0700X
NY096141104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker