Provider Demographics
NPI:1437925666
Name:TAVARES, ROSY ELISABETH (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:ROSY
Middle Name:ELISABETH
Last Name:TAVARES
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 PRESIDENTIAL DR APT 3
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-8848
Mailing Address - Country:US
Mailing Address - Phone:617-866-7824
Mailing Address - Fax:
Practice Address - Street 1:79 PRESIDENTIAL DR APT 3
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-8848
Practice Address - Country:US
Practice Address - Phone:617-866-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician