Provider Demographics
NPI:1639248388
Name:SHARMA, TULSI (LICSW)
Entity Type:Individual
Prefix:
First Name:TULSI
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LUCAS DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3453
Mailing Address - Country:US
Mailing Address - Phone:781-341-8509
Mailing Address - Fax:508-543-3692
Practice Address - Street 1:40 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2074
Practice Address - Country:US
Practice Address - Phone:508-543-8888
Practice Address - Fax:508-543-3692
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1072271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP05771Medicare ID - Type Unspecified