Provider Demographics
NPI:1346522927
Name:TANGUAY, REBECCA NICOLE (LICSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:NICOLE
Last Name:TANGUAY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BUFFINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-4810
Mailing Address - Country:US
Mailing Address - Phone:774-704-6681
Mailing Address - Fax:508-617-8096
Practice Address - Street 1:122 BUFFINGTON ST
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4810
Practice Address - Country:US
Practice Address - Phone:774-704-6681
Practice Address - Fax:508-617-8096
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1200261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110140100BMedicaid