Provider Demographics
NPI:1457090045
Name:LOUIS, TAMARH REBECCA
Entity Type:Individual
Prefix:
First Name:TAMARH
Middle Name:REBECCA
Last Name:LOUIS
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 1:19A LISBON ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5912
Mailing Address - Country:US
Mailing Address - Phone:781-632-7670
Mailing Address - Fax:
Practice Address - Street 1:19A LISBON ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5912
Practice Address - Country:US
Practice Address - Phone:781-632-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician