Provider Demographics
NPI:1417272865
Name:ARISTILDE, TAMARRA J (LMFT, NCC)
Entity Type:Individual
Prefix:MRS
First Name:TAMARRA
Middle Name:J
Last Name:ARISTILDE
Suffix:
Gender:F
Credentials:LMFT, NCC
Other - Prefix:MRS
Other - First Name:TAMARRA
Other - Middle Name:J
Other - Last Name:ARISTILDE-CALIXTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT, NCC
Mailing Address - Street 1:P. O BOX 405
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02303
Mailing Address - Country:US
Mailing Address - Phone:774-269-2459
Mailing Address - Fax:508-559-1304
Practice Address - Street 1:484 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2535
Practice Address - Country:US
Practice Address - Phone:774-269-2459
Practice Address - Fax:508-559-1304
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 106H00000X
MA1495106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional