Provider Demographics
NPI:1487845111
Name:TARBELL, BEVERLY (LICAC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:TARBELL
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 APPLETON ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1346
Mailing Address - Country:US
Mailing Address - Phone:617-492-1263
Mailing Address - Fax:
Practice Address - Street 1:665 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-2953
Practice Address - Country:US
Practice Address - Phone:508-405-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226465171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist