MEDICARE: THOMAS J. TANGUAY LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	100551	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22414-1	OTHER	RI	BLUE CROSS OF RI
2	411588	OTHER	MA	TUFTS HEALTH CARE
3	P01672	OTHER	MA	BLUE CROSS OF MA
4	1891901	OTHER	MA	MBHP AKA THE PARTNERSHIP
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154317071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS J. TANGUAY LICSW

Provider Business Mailing Address
First Line	:	1360 MIDDLEBORO AVE
Second Line	:
City	:	EAST TAUNTON
State	:	MA
Zip	:	02718-1500
Country	:	US
Telephone Number	:	508-813-3892
Fax Number	:	508-947-1684

Provider Business Practice Location Address
First Line	:	104 CHARLES ELDRIDGE RD
Second Line	:
City	:	LAKEVILLE
State	:	MA
Zip	:	02347-1388
Country	:	US
Telephone Number	:	508-813-3892
Fax Number	:	508-947-1684

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	07/09/2007

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