Provider Demographics
NPI:1487440962
Name:MUMBI, TABITHA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:MUMBI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ORONO ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1062
Mailing Address - Country:US
Mailing Address - Phone:508-450-7155
Mailing Address - Fax:508-926-8506
Practice Address - Street 1:22 ORONO ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1062
Practice Address - Country:US
Practice Address - Phone:508-450-7155
Practice Address - Fax:508-926-8506
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2266483363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health