Provider Demographics
NPI:1902170335
Name:TAMBURELLI, VINCENT (LCSW)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:TAMBURELLI
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 1:1919 NE 45TH ST
Mailing Address - Street 2:SUITE 122
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5131
Mailing Address - Country:US
Mailing Address - Phone:954-776-7176
Mailing Address - Fax:954-776-7160
Practice Address - Street 1:1919 NE 45TH ST
Practice Address - Street 2:SUITE 122
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5131
Practice Address - Country:US
Practice Address - Phone:954-776-7176
Practice Address - Fax:954-776-7160
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW43771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical