Provider Demographics
NPI:1790791150
Name:VALICENTI, TAMARA ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:ANN
Last Name:VALICENTI
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 1:33 PIXLEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOUSATONIC
Mailing Address - State:MA
Mailing Address - Zip Code:01236-9766
Mailing Address - Country:US
Mailing Address - Phone:413-519-4830
Mailing Address - Fax:
Practice Address - Street 1:89 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2505
Practice Address - Country:US
Practice Address - Phone:413-519-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1115361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23773Medicare ID - Type Unspecified