Provider Demographics
NPI:1790831337
Name:SURETTE, TARA NICOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:NICOLE
Last Name:SURETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BURDITT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2115
Mailing Address - Country:US
Mailing Address - Phone:978-207-1174
Mailing Address - Fax:
Practice Address - Street 1:20 BURDITT RD
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-2115
Practice Address - Country:US
Practice Address - Phone:978-207-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2133161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical