Provider Demographics
NPI:1104681006
Name:TAMTOMO, BETTY MARCIA (LCSW)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:MARCIA
Last Name:TAMTOMO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 N LOARA ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3618
Mailing Address - Country:US
Mailing Address - Phone:714-307-8428
Mailing Address - Fax:
Practice Address - Street 1:351 N ARROWHEAD AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0245
Practice Address - Country:US
Practice Address - Phone:909-521-3169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115071041C0700X
CA769141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical