Provider Demographics
NPI:1376001594
Name:KESSELMAN, TAMARA S (LICSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:S
Last Name:KESSELMAN
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 1:128 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1405
Mailing Address - Country:US
Mailing Address - Phone:401-390-4848
Mailing Address - Fax:
Practice Address - Street 1:128 BROOK RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1405
Practice Address - Country:US
Practice Address - Phone:401-390-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107428104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1376001594OtherBLUE CROSS BLUE SHIELD
MA1376001594OtherAETNA
MA1376001594OtherTUFTS HEALTH PLAN
MA1376001594OtherPILGRIM HEALTH PLAN
MA1376001594OtherCIGNA
MA1376001594OtherHEALTHMARKETS
MA107428-SW-LICSWMedicaid