Provider Demographics
NPI:1578325437
Name:TETRA BEHAVIORAL SERVICES PLLC
Entity Type:Organization
Organization Name:TETRA BEHAVIORAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:SARAH
Authorized Official - Last Name:WAITHIRA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:508-933-9665
Mailing Address - Street 1:167 WASHINGTON ST STE 42
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1797
Mailing Address - Country:US
Mailing Address - Phone:508-933-9665
Mailing Address - Fax:
Practice Address - Street 1:167 WASHINGTON ST STE 42
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1797
Practice Address - Country:US
Practice Address - Phone:508-933-9665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TETRA BEHAVIORAL SERVICES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)