Healthcare Provider Details

I. General information

NPI: 1295923605
Provider Name (Legal Business Name): CATHERINE M. TSAROUHAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ZERO GOVENORS AVE #20
MEDFORD MA
02155
US

IV. Provider business mailing address

PO BOX 791
MEDFORD MA
02155
US

V. Phone/Fax

Practice location:
  • Phone: 781-396-5575
  • Fax:
Mailing address:
  • Phone: 781-396-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1017992
License Number StateMA

VIII. Authorized Official

Name: MS. CATHERINE M TSAROUHAS
Title or Position: DIRECTOR
Credential: LICSW
Phone: 781-396-5575