Individual
TANIA I MONTANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TOBACCO TREATMENT CO
Contact information
Practice address
19 TACOMA ST, WORCESTER, MA 01605-3516
(508) 852-1805
(508) 853-8593
Mailing address
19 TACOMA ST, WORCESTER, MA 01605-3516
(508) 852-1805
(508) 853-8593
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1301071
GBVHC MEDICAID GROUP #
MA
Enumeration date
08/13/2009
Last updated
08/13/2009
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