Provider Demographics
NPI:1912007592
Name:ZUMBO, TAMMY (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:
Last Name:ZUMBO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 S PERRY ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2315
Mailing Address - Country:US
Mailing Address - Phone:518-893-1687
Mailing Address - Fax:518-863-3075
Practice Address - Street 1:41 S PERRY ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095
Practice Address - Country:US
Practice Address - Phone:518-893-1687
Practice Address - Fax:518-863-3075
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042995-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA6518Medicare ID - Type Unspecified