Provider Demographics
NPI:1710064746
Name:TARDIFF, CHRISTINE E (LICSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:TARDIFF
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 1:13 DEARBORN AVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2226
Mailing Address - Country:US
Mailing Address - Phone:508-932-2487
Mailing Address - Fax:
Practice Address - Street 1:13 DEARBORN AVE
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3407
Practice Address - Country:US
Practice Address - Phone:508-932-2487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10327871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1857088Medicaid
MA1857088Medicaid