Provider Demographics
NPI:1477265536
Name:TAVAREZ, LILLIAN M
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:M
Last Name:TAVAREZ
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 1:50 ISLAND ST APT 512
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1876
Mailing Address - Country:US
Mailing Address - Phone:978-590-7232
Mailing Address - Fax:
Practice Address - Street 1:370 MERRIMACK ST BLDG 5
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1788
Practice Address - Country:US
Practice Address - Phone:978-620-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health