Provider Demographics
NPI:1083347843
Name:TAVAREZ DE OLIVEIRA, HARONIS
Entity Type:Individual
Prefix:MRS
First Name:HARONIS
Middle Name:
Last Name:TAVAREZ DE OLIVEIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757 CLAY DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-9233
Mailing Address - Country:US
Mailing Address - Phone:718-207-9780
Mailing Address - Fax:
Practice Address - Street 1:3757 CLAY DR
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-9233
Practice Address - Country:US
Practice Address - Phone:718-207-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101Y00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty