Provider Demographics
NPI:1538806856
Name:GIBBONS, TAMARA BAKER (LACMH)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:BAKER
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:LACMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19266 COASTAL HWY UNIT 4-1173
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-6117
Mailing Address - Country:US
Mailing Address - Phone:302-515-6939
Mailing Address - Fax:
Practice Address - Street 1:19266 COASTAL HWY UNIT 4-1173
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-6117
Practice Address - Country:US
Practice Address - Phone:302-515-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEAC-0010326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health