Provider Demographics
NPI:1720896657
Name:TUMMINO, ELISE BRITTNEY
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:BRITTNEY
Last Name:TUMMINO
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 1:16 BRIDGE GATE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-6377
Mailing Address - Country:US
Mailing Address - Phone:508-287-8692
Mailing Address - Fax:508-591-7886
Practice Address - Street 1:16 BRIDGE GATE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-6377
Practice Address - Country:US
Practice Address - Phone:508-287-8692
Practice Address - Fax:508-591-7886
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician