Provider Demographics
NPI:1811225147
Name:TIDMAN, TAMARA ALICIA (MSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ALICIA
Last Name:TIDMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 JAQUES AVE
Mailing Address - Street 2:FAMILIES AND COMMUNITIES TOGETHER
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2476
Mailing Address - Country:US
Mailing Address - Phone:508-373-7947
Mailing Address - Fax:508-421-4493
Practice Address - Street 1:72 JAQUES AVE
Practice Address - Street 2:FAMILIES AND COMMUNITIES TOGETHER
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610
Practice Address - Country:US
Practice Address - Phone:508-373-7947
Practice Address - Fax:508-421-4493
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health