Provider Demographics
NPI:1033617089
Name:MILLER, TARA LYNN
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LYNN
Other - Last Name:KIRCHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, RBT
Mailing Address - Street 1:701 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3904
Mailing Address - Country:US
Mailing Address - Phone:856-381-4622
Mailing Address - Fax:856-381-4622
Practice Address - Street 1:701 CHAPEL RD
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3904
Practice Address - Country:US
Practice Address - Phone:856-381-4622
Practice Address - Fax:856-381-4622
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-16-23234106S00000X
1-19-35664103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician