Provider Demographics
NPI:1033567029
Name:TABALA, BARBARA (CASAC-G)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:TABALA
Suffix:
Gender:F
Credentials:CASAC-G
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GEDNEY ST
Mailing Address - Street 2:APT 6G
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 ROUTE 59
Practice Address - Street 2:SUITE 117
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10901-4927
Practice Address - Country:US
Practice Address - Phone:845-369-9701
Practice Address - Fax:845-369-9704
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2353101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)