Provider Demographics
NPI:1871046730
Name:SURFACE-TABBI, MARY TATUM (CPS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:TATUM
Last Name:SURFACE-TABBI
Suffix:
Gender:F
Credentials:CPS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:TATUM
Other - Last Name:SURFACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPS
Mailing Address - Street 1:50 LYNNWAY APT.712
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902
Mailing Address - Country:US
Mailing Address - Phone:781-715-5598
Mailing Address - Fax:
Practice Address - Street 1:50 LYNNWAY APT 712
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4637
Practice Address - Country:US
Practice Address - Phone:781-715-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor