Individual
ELIZABETH TAVARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
85 LUKE ST, NEW BEDFORD, MA 02740-1329
(774) 992-6465
Mailing address
85 LUKE ST, NEW BEDFORD, MA 02740-1329
(774) 992-6465
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801935176
ARC
—
Enumeration date
05/04/2018
Last updated
06/16/2018
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