Healthcare Provider Details

I. General information

NPI: 1699823195
Provider Name (Legal Business Name): CATHERINE ELISE TARNOWSKI LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE ELISE MCMANUS LICSW

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 BALD HILL RD
NEWFIELDS NH
03856-8100
US

IV. Provider business mailing address

72 BALD HILL RD
NEWFIELDS NH
03856-8100
US

V. Phone/Fax

Practice location:
  • Phone: 978-852-5355
  • Fax: 603-499-4801
Mailing address:
  • Phone: 978-852-5355
  • Fax: 603-499-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1032238
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1997
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP08128
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier1106340
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBEACON HEALTH STRATEGIES
# 3
Identifier1852655
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 4
Identifier3107475
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: