Provider Demographics
NPI:1124151022
Name:SERPA, TINA A (LADC-I)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:A
Last Name:SERPA
Suffix:
Gender:F
Credentials:LADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4217
Mailing Address - Country:US
Mailing Address - Phone:774-930-7369
Mailing Address - Fax:
Practice Address - Street 1:25W OLD WESTPORT RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2513
Practice Address - Country:US
Practice Address - Phone:774-930-7369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4024247104100000X
MA19541101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker