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Individual
TEGAN MALLARY POLHAMUS
Active
Individual
TEGAN MALLARY POLHAMUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
120986
MA
104100000X
Social Worker
221026
MA
Other
Enumeration date
06/30/2011
Last updated
01/30/2018
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