Provider Demographics
NPI:1235779455
Name:GANS, TARA (MA, MFT)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:GANS
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SHERWOOD FARMS
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-6155
Mailing Address - Country:US
Mailing Address - Phone:203-349-5902
Mailing Address - Fax:
Practice Address - Street 1:116 MILE COMMON RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:CT
Practice Address - Zip Code:06612-1506
Practice Address - Country:US
Practice Address - Phone:203-916-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2282106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist