Doctor Name: | TARA VIRGIL |
NPI Number: | 1164714986 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 400 Sunrise Hwy Carone Hall 1st Floor Amityville, NY - 117012508 |
Business Phone Number: | 6316085028 |
Business Fax Number: | 6312644509 |
Mailing Address: | 400 Sunrise Hwy, Carone Hall 1st Floor AMITYVILLE |
State: | NY |
Postal Code: | 117012508 |
Phone Number: | 6316085028 |
Fax Number: | 6312644509 |
NPI Enumeration Date: | 05/12/2011 |
NPI Last Update Date: | 05/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |