Provider Demographics
NPI:1154317071
Name:TANGUAY, THOMAS J (LICSW)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:TANGUAY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 MIDDLEBORO AVE
Mailing Address - Street 2:
Mailing Address - City:EAST TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02718-1500
Mailing Address - Country:US
Mailing Address - Phone:508-813-3892
Mailing Address - Fax:508-947-1684
Practice Address - Street 1:104 CHARLES ELDRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1388
Practice Address - Country:US
Practice Address - Phone:508-813-3892
Practice Address - Fax:508-947-1684
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1005511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI22414-1OtherBLUE CROSS OF RI
MA411588OtherTUFTS HEALTH CARE
MAP01672OtherBLUE CROSS OF MA
MA1891901OtherMBHP AKA THE PARTNERSHIP
MA1851993Medicaid
RI22414-1OtherBLUE CROSS OF RI