Provider Demographics
NPI:1376240432
Name:TAMMIK, KERRIN JEANNE KNIGHT
Entity Type:Individual
Prefix:
First Name:KERRIN
Middle Name:JEANNE KNIGHT
Last Name:TAMMIK
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 1:83 FLINT RD
Mailing Address - Street 2:
Mailing Address - City:ASHBY
Mailing Address - State:MA
Mailing Address - Zip Code:01431-1731
Mailing Address - Country:US
Mailing Address - Phone:978-502-0668
Mailing Address - Fax:
Practice Address - Street 1:76 SUMMER ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-0200
Practice Address - Country:US
Practice Address - Phone:978-602-4957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst