Provider Demographics
NPI:1295412559
Name:TEM, EMMANUELLA
Entity type:Individual
Prefix:
First Name:EMMANUELLA
Middle Name:
Last Name:TEM
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 1:50 ADAMS ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1683
Mailing Address - Country:US
Mailing Address - Phone:410-982-3467
Mailing Address - Fax:
Practice Address - Street 1:50 ADAMS ST UNIT 201
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1683
Practice Address - Country:US
Practice Address - Phone:443-851-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health