Provider Demographics
NPI:1699823195
Name:TARNOWSKI, CATHERINE ELISE (LICSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELISE
Last Name:TARNOWSKI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ELISE
Other - Last Name:MCMANUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:72 BALD HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWFIELDS
Mailing Address - State:NH
Mailing Address - Zip Code:03856-8100
Mailing Address - Country:US
Mailing Address - Phone:978-852-5355
Mailing Address - Fax:603-499-4801
Practice Address - Street 1:72 BALD HILL RD
Practice Address - Street 2:
Practice Address - City:NEWFIELDS
Practice Address - State:NH
Practice Address - Zip Code:03856-8100
Practice Address - Country:US
Practice Address - Phone:978-852-5355
Practice Address - Fax:603-499-4801
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10322381041C0700X
NH19971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08128OtherBLUE CROSS BLUE SHIELD
MA1106340OtherBEACON HEALTH STRATEGIES
MA1852655Medicaid
NH3107475Medicaid