Provider Demographics
NPI:1891920229
Name:MAINEMER, TAMI ESTHER (LICSW)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:ESTHER
Last Name:MAINEMER
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 1:126 PHOENIX AVE
Mailing Address - Street 2:THOM ANNE SULLIVAN CENTER
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-4931
Mailing Address - Country:US
Mailing Address - Phone:978-453-8331
Mailing Address - Fax:978-453-9254
Practice Address - Street 1:126 PHOENIX AVE
Practice Address - Street 2:THOM ANNE SULLIVAN CENTER
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4931
Practice Address - Country:US
Practice Address - Phone:978-453-8331
Practice Address - Fax:978-453-9254
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1147181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical