Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 000008585 | MA |
NPI | 1003244849 |
---|---|
Provider Name | Mercy Tandoh |
First Address | South Grafton, MA 01560-1253 |
Second Address | Northborough, MA 01532-2132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2013 |
Last Update Date | 12/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1851681845 | NATIONAL PROVIDER IDENTIFIER (01) | MA |