Provider Demographics
NPI:1649365263
Name:D'URSO, TAMMY-SUE CATHERINE (LICSW)
Entity type:Individual
Prefix:
First Name:TAMMY-SUE
Middle Name:CATHERINE
Last Name:D'URSO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TAMMY-SUE
Other - Middle Name:CATHERINE
Other - Last Name:BLONDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-4068
Mailing Address - Country:US
Mailing Address - Phone:603-579-5117
Mailing Address - Fax:
Practice Address - Street 1:29 NORTHWEST BLVD
Practice Address - Street 2:FOUNDATION PSYCHIATRIC ASSOCIATES
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063
Practice Address - Country:US
Practice Address - Phone:603-881-9313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH925104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30422431Medicaid
NHRE6589Medicare ID - Type Unspecified