Provider Demographics
NPI:1477064293
Name:TAVARES, SABINA FERREIRA (CNP)
Entity Type:Individual
Prefix:
First Name:SABINA
Middle Name:FERREIRA
Last Name:TAVARES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 PUTNAM ST APT 3
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1461
Mailing Address - Country:US
Mailing Address - Phone:617-359-2146
Mailing Address - Fax:
Practice Address - Street 1:529 PEARL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2825
Practice Address - Country:US
Practice Address - Phone:508-580-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN22671372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2267137OtherNP LISENCE