Provider Demographics
NPI:1497576771
Name:TATA, MARIA (MS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:TATA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WILLARD RD
Mailing Address - Street 2:
Mailing Address - City:ASHBURNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01430-1429
Mailing Address - Country:US
Mailing Address - Phone:603-897-5935
Mailing Address - Fax:
Practice Address - Street 1:450 BEDFORD ST STE 2400
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1535
Practice Address - Country:US
Practice Address - Phone:781-633-7779
Practice Address - Fax:617-458-8644
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor