MEDICARE: MISS TAMMY RACHEL GREENE LMHC, MA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1588688410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TAMMY RACHEL GREENE LMHC, MA

Provider Business Mailing Address
First Line	:	18A SPRING CT
Second Line	:
City	:	WOBURN
State	:	MA
Zip	:	01801-4424
Country	:	US
Telephone Number	:	617-543-5730
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 MASSACHUSETTS AVE
Second Line	:	SUITE 83
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3067
Country	:	US
Telephone Number	:	617-543-5730
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	02/28/2009

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