Provider Demographics
NPI:1053730812
Name:MARCUM, TAMMY L (LISW RPT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:MARCUM
Suffix:
Gender:F
Credentials:LISW RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 1/2 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3910
Mailing Address - Country:US
Mailing Address - Phone:614-918-8120
Mailing Address - Fax:
Practice Address - Street 1:2266 1/2 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-3910
Practice Address - Country:US
Practice Address - Phone:614-918-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00045291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical