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Provider Information for 1114348521


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TAMMARA L ROOD LMFT


Sex: Female

NPI: 1114348521
Last Updated: 2014-01-02
Certification Date:

Details

NameValue
NPI1114348521
Enumeration Date2014-01-02
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 1045 JAMES ST
SYRACUSE, NY 13203-2730
United States

Phone: 315-472-4471 | Fax:315-472-1759
 
Primary Practice Address 1045 JAMES ST
SYRACUSE, NY 13203-2730
United States

Phone: 315-472-4471 | Fax:315-472-1759
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDNY001073
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 106H00000X - Marriage & Family Therapist NY001073