Provider Demographics
NPI:1154626851
Name:AQUINO, TARA MARIE (MS CAS)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:MARIE
Last Name:AQUINO
Suffix:
Gender:F
Credentials:MS CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:61 MCKINLEY AVE
Mailing Address - Street 2:APT A
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7134
Mailing Address - Country:US
Mailing Address - Phone:716-353-1194
Mailing Address - Fax:
Practice Address - Street 1:51 ST JOHNS PARKSIDE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-2515
Practice Address - Country:US
Practice Address - Phone:716-828-9560
Practice Address - Fax:716-828-9460
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY433781101103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool