Healthcare Provider Details

I. General information

NPI: 1518546795
Provider Name (Legal Business Name): KIMARILIS TOVAR BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 GOLD STAR BLVD
WORCESTER MA
01606-2738
US

IV. Provider business mailing address

91 PLEASANT ST
SPENCER MA
01562-1631
US

V. Phone/Fax

Practice location:
  • Phone: 855-496-8462
  • Fax:
Mailing address:
  • Phone: 774-275-7965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: