Provider Demographics
NPI:1225527369
Name:ADAMS, TINA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:R
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ST CLAIR RD
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01010-2120
Mailing Address - Country:US
Mailing Address - Phone:413-245-1487
Mailing Address - Fax:413-245-1629
Practice Address - Street 1:12 ST CLAIR RD
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:MA
Practice Address - Zip Code:01010-2120
Practice Address - Country:US
Practice Address - Phone:413-245-1487
Practice Address - Fax:413-245-1629
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7790103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical