Provider Demographics
NPI:1447790787
Name:TASSINARI, KIM M (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:M
Last Name:TASSINARI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 S MAIN ST
Mailing Address - Street 2:BUILDING C
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2356
Mailing Address - Country:US
Mailing Address - Phone:203-313-4313
Mailing Address - Fax:
Practice Address - Street 1:84 S MAIN ST
Practice Address - Street 2:BLDG C
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2356
Practice Address - Country:US
Practice Address - Phone:203-270-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001945101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional