Provider Demographics
NPI:1861980054
Name:TOMARO'S CHANGE
Entity type:Organization
Organization Name:TOMARO'S CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER - EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOMARO
Authorized Official - Middle Name:M
Authorized Official - Last Name:PILGRIM
Authorized Official - Suffix:
Authorized Official - Credentials:MSC, MSHS, LMSW
Authorized Official - Phone:844-222-8500
Mailing Address - Street 1:1261 PARISH AVE
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-3338
Mailing Address - Country:US
Mailing Address - Phone:844-222-8500
Mailing Address - Fax:844-222-8986
Practice Address - Street 1:3301 GREEN ST STE 235
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703
Practice Address - Country:US
Practice Address - Phone:844-222-8500
Practice Address - Fax:844-222-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1548715451Medicaid