Provider Demographics
NPI:1457484081
Name:TAMAREN, KIM ILENE (MS,LMHC)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:ILENE
Last Name:TAMAREN
Suffix:
Gender:F
Credentials:MS,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RUSSELL CIR
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1223
Mailing Address - Country:US
Mailing Address - Phone:781-302-4771
Mailing Address - Fax:781-302-4635
Practice Address - Street 1:1 RUSSELL CIR
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1223
Practice Address - Country:US
Practice Address - Phone:781-302-4771
Practice Address - Fax:781-302-4635
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional