Provider Demographics
NPI:1942055322
Name:FEITOSA, THAMAR
Entity Type:Individual
Prefix:
First Name:THAMAR
Middle Name:
Last Name:FEITOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 PLEASANT ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-1956
Mailing Address - Country:US
Mailing Address - Phone:774-386-6445
Mailing Address - Fax:
Practice Address - Street 1:785 PLEASANT ST APT 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-1956
Practice Address - Country:US
Practice Address - Phone:774-386-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician