Provider Demographics
NPI:1275052268
Name:TAMMARO, KAITLYN A (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:A
Last Name:TAMMARO
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:MISS
Other - First Name:KAITLYN
Other - Middle Name:A
Other - Last Name:WENZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5955 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-3936
Mailing Address - Country:US
Mailing Address - Phone:440-332-4604
Mailing Address - Fax:440-888-1686
Practice Address - Street 1:5955 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-3936
Practice Address - Country:US
Practice Address - Phone:440-332-4604
Practice Address - Fax:440-888-1686
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2203549-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical