Provider Demographics
NPI:1053058552
Name:JANEGO, TARA (MS, RMHCI IMH #18396)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:JANEGO
Suffix:
Gender:F
Credentials:MS, RMHCI IMH #18396
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N WYMORE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2822
Mailing Address - Country:US
Mailing Address - Phone:407-984-7691
Mailing Address - Fax:
Practice Address - Street 1:315 N WYMORE RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2822
Practice Address - Country:US
Practice Address - Phone:407-984-7691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health