Provider Demographics
NPI:1356975502
Name:TAVARES, JAMES MICHAEL (M ED)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:TAVARES
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4235
Mailing Address - Country:US
Mailing Address - Phone:978-866-2939
Mailing Address - Fax:
Practice Address - Street 1:475 WHEELER RD
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-4235
Practice Address - Country:US
Practice Address - Phone:978-866-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician