Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 9517 | MA |
NPI | 1306172622 |
---|---|
Provider Name | Mrs. Tammy L. Page |
First Address | Springfield, MA 01105-1864 |
Second Address | Springfield, MA 01105-1864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2009 |
Last Update Date | 22/03/2012 |