Provider Demographics
NPI:1639640287
Name:FAINTUCH, TAMAR ESTHER (LICSW)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:ESTHER
Last Name:FAINTUCH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LINCOLN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1561
Mailing Address - Country:US
Mailing Address - Phone:857-540-5855
Mailing Address - Fax:
Practice Address - Street 1:24 LINCOLN ST STE 3
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1561
Practice Address - Country:US
Practice Address - Phone:857-540-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MA122784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker