Healthcare Provider Details

I. General information

NPI: 1811620073
Provider Name (Legal Business Name): TAMARA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MERRIMACK ST BLDG 5
LAWRENCE MA
01843-1788
US

IV. Provider business mailing address

370 MERRIMACK ST
LAWRENCE MA
01843-1788
US

V. Phone/Fax

Practice location:
  • Phone: 978-327-2907
  • Fax:
Mailing address:
  • Phone: 978-620-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: