Healthcare Provider Details

I. General information

NPI: 1437367083
Provider Name (Legal Business Name): TAMAH P SENOSK M.S., L.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 FIRST ST
NORTH GROSVENORDALE CT
06255-1614
US

IV. Provider business mailing address

22 FIRST ST
NORTH GROSVENORDALE CT
06255-1614
US

V. Phone/Fax

Practice location:
  • Phone: 508-765-9167
  • Fax: 508-764-2462
Mailing address:
  • Phone: 508-765-9167
  • Fax: 508-764-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number313125
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: