Individual
TINA KIM LE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
340 MAIN ST, WORCESTER, MA 01608-1604
(508) 791-4976
Mailing address
340 MAIN ST, WORCESTER, MA 01608-1604
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
MA
Other
Enumeration date
10/04/2017
Last updated
10/04/2017
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