Provider Demographics
NPI:1194533695
Name:REMILLARD, TABATHA DAWN
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:DAWN
Last Name:REMILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 PAGE ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1124
Mailing Address - Country:US
Mailing Address - Phone:781-436-8492
Mailing Address - Fax:
Practice Address - Street 1:63 1/2 MAPLE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-3445
Practice Address - Country:US
Practice Address - Phone:603-548-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical