Individual
DR. TINEKE CARMAN VANDEGRIFT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
30 DOMINO DR STE 2, CONCORD, MA 01742-2802
(978) 263-1611
(978) 776-2321
Mailing address
PO BOX 664, ACTON, MA 01720-0664
(978) 263-1611
(978) 776-2321
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
7174
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
250942000
MAGELLAN
MA
01
—
W05812
BLUE CROSS BLUE SHIELD
MA
Enumeration date
12/06/2006
Last updated
06/03/2016
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