Provider Demographics
NPI:1447057112
Name:MAMO, TSEGAYE
Entity type:Individual
Prefix:
First Name:TSEGAYE
Middle Name:
Last Name:MAMO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11720 BELTSVILLE DR # 500A15
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3166
Mailing Address - Country:US
Mailing Address - Phone:202-790-8903
Mailing Address - Fax:301-889-9735
Practice Address - Street 1:11720 BELTSVILLE DR # 500A15
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3166
Practice Address - Country:US
Practice Address - Phone:202-790-8903
Practice Address - Fax:301-889-9735
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst