Healthcare Provider Details

I. General information

NPI: 1487381083
Provider Name (Legal Business Name): TAMARA MAURICE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 HUNTINGTON AVE FL 14
BOSTON MA
02115-3134
US

IV. Provider business mailing address

177 HUNTINGTON AVE FL 14
BOSTON MA
02115-3134
US

V. Phone/Fax

Practice location:
  • Phone: 888-572-0795
  • Fax: 978-496-8771
Mailing address:
  • Phone: 888-572-0795
  • Fax: 978-496-8771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number229609
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: