Provider Demographics
NPI:1225490386
Name:TANDY, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:TANDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 HASTINGS HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01378-7825
Mailing Address - Country:US
Mailing Address - Phone:413-834-2212
Mailing Address - Fax:
Practice Address - Street 1:147 HASTINGS HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:MA
Practice Address - Zip Code:01378-7825
Practice Address - Country:US
Practice Address - Phone:413-834-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA100031553207Medicaid