Most Relevant Information
Provider Data
| NPI Number: | 1003571969 |
| Provider Name: | TANYA JACQUELINE LUNGELOW |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 123456 |
Most Important Dates
| Enumeration Date: | 11/05/2021 |
| Last Updated: | 11/05/2021 |
Provider Practice Location
869 MAIN ST STE 6B
WALPOLE
MA
020812985
Practice Location Phone/Fax
| Phone: | 7812699978 |
| Fax: |
Provider Mailing Location
23 LINDSEY ST
BOSTON
MA
021241309
Provider Mailing Phone/Fax
| Phone: | 6177926693 |
| Fax: |