Provider Demographics
NPI:1629308291
Name:CRENSHAW, TAMERA A
Entity type:Individual
Prefix:
First Name:TAMERA
Middle Name:A
Last Name:CRENSHAW
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 1:264 N MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1837
Mailing Address - Country:US
Mailing Address - Phone:860-461-7792
Mailing Address - Fax:860-650-0567
Practice Address - Street 1:264 N MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1837
Practice Address - Country:US
Practice Address - Phone:860-461-7792
Practice Address - Fax:860-650-0567
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health