=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356628531
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUIS F TAMAYO PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2011
-----------------------------------------------------
Last Update Date | 11/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 WASHINGTON ST
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02062-2205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-669-9145
-----------------------------------------------------
Fax | 617-524-0961
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 359 S HUNTINGTON AVE
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02130-4887
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-669-9145
-----------------------------------------------------
Fax | 617-524-0961
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 8103
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------