Provider Demographics
NPI:1891816732
Name:LIQUORI, TANYA RENEE (MED, LADC1, CCDP-D)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:RENEE
Last Name:LIQUORI
Suffix:
Gender:F
Credentials:MED, LADC1, CCDP-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-1589
Mailing Address - Country:US
Mailing Address - Phone:413-746-0051
Mailing Address - Fax:413-746-0368
Practice Address - Street 1:628 CENTER ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1589
Practice Address - Country:US
Practice Address - Phone:413-746-0051
Practice Address - Fax:413-746-0368
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2009-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2149101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)