Healthcare Provider Details

I. General information

NPI: 1639640287
Provider Name (Legal Business Name): TAMAR ESTHER FAINTUCH LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 08/30/2020
Certification Date: 08/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 LINCOLN ST STE 3
NEWTON HIGHLANDS MA
02461-1561
US

IV. Provider business mailing address

24 LINCOLN ST STE 3
NEWTON HIGHLANDS MA
02461-1561
US

V. Phone/Fax

Practice location:
  • Phone: 857-540-5855
  • Fax:
Mailing address:
  • Phone: 857-540-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number122784
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: