Provider Demographics
NPI:1528483682
Name:CARR, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:M
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX H
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04631-0909
Mailing Address - Country:US
Mailing Address - Phone:207-853-6001
Mailing Address - Fax:207-853-4031
Practice Address - Street 1:30 BOYNTON ST
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:ME
Practice Address - Zip Code:04631-1306
Practice Address - Country:US
Practice Address - Phone:207-853-6001
Practice Address - Fax:207-853-4031
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4285101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional