Individual
AMANDA TATLOCK NASCIMENTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LCGC
Contact information
Practice address
55 SAYLES ST, SOUTHBRIDGE, MA 01550-1729
(508) 764-2400
(508) 909-7770
Mailing address
7 RUSTIC DR, NORTHBOROUGH, MA 01532-2315
(508) 523-9725
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
GC056
MA
171400000X
Health & Wellness Coach
A-3628849
—
Other
Enumeration date
01/16/2020
Last updated
05/29/2023
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