Provider Demographics
NPI:1750418034
Name:TSAROUHAS, CATHERINE M (LICSW CPSI CADAC II)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:M
Last Name:TSAROUHAS
Suffix:
Gender:F
Credentials:LICSW CPSI CADAC II
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:WHITE
Other - Last Name:TSAROUHAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155
Mailing Address - Country:US
Mailing Address - Phone:781-396-5575
Mailing Address - Fax:
Practice Address - Street 1:ZERO GOVERNORS AVE
Practice Address - Street 2:#20
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:781-396-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YA0400X
MA10179921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1891529Medicaid
MAP05172Medicare ID - Type Unspecified