Provider Demographics
NPI:1225892623
Name:SOVIK-BANDEL, TARA HELEN (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:HELEN
Last Name:SOVIK-BANDEL
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SCAGLIONE CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-2326
Mailing Address - Country:US
Mailing Address - Phone:845-535-1551
Mailing Address - Fax:
Practice Address - Street 1:2250 GOSHEN TPKE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4031
Practice Address - Country:US
Practice Address - Phone:845-673-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000459-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst