Provider Demographics
NPI:1487743811
Name:TAMULEVICH, JANE (PHD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:TAMULEVICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3445
Mailing Address - Country:US
Mailing Address - Phone:781-335-6000
Mailing Address - Fax:781-340-5358
Practice Address - Street 1:49 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2435
Practice Address - Country:US
Practice Address - Phone:781-335-6000
Practice Address - Fax:781-340-5358
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7362103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW40005Medicare ID - Type Unspecified