Provider Demographics
NPI:1700410990
Name:PINNOCK, TENNILLE
Entity Type:Individual
Prefix:
First Name:TENNILLE
Middle Name:
Last Name:PINNOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 TREMONT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2193
Mailing Address - Country:US
Mailing Address - Phone:617-445-4075
Mailing Address - Fax:
Practice Address - Street 1:1059 TREMONT ST STE 2
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02120-2193
Practice Address - Country:US
Practice Address - Phone:617-445-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator