Provider Demographics
NPI:1083733646
Name:ROQUE, TARA LYNN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:LYNN
Last Name:ROQUE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02724-2118
Mailing Address - Country:US
Mailing Address - Phone:508-642-5818
Mailing Address - Fax:
Practice Address - Street 1:35 STATE RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-3511
Practice Address - Country:US
Practice Address - Phone:508-674-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health