Provider Demographics
NPI:1700358660
Name:URENA, TAMAR
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:
Last Name:URENA
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 1:6 MEREDITH ST APT L
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2719
Mailing Address - Country:US
Mailing Address - Phone:914-619-1697
Mailing Address - Fax:
Practice Address - Street 1:6 MEREDITH ST APT L
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2719
Practice Address - Country:US
Practice Address - Phone:914-619-1697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY849909246Medicaid