Provider Demographics
NPI:1033706361
Name:TABB, MARSHA LATRICE (ADVANCED CASAC)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:LATRICE
Last Name:TABB
Suffix:
Gender:F
Credentials:ADVANCED CASAC
Other - Prefix:MRS
Other - First Name:MARSHA
Other - Middle Name:LATRICE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 LONGMEADOW RD APT A
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2974
Mailing Address - Country:US
Mailing Address - Phone:716-578-8685
Mailing Address - Fax:
Practice Address - Street 1:430 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1886
Practice Address - Country:US
Practice Address - Phone:716-853-1335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)