Provider Demographics
NPI:1255692497
Name:CACACE, TARA ANN (MS, ED)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ANN
Last Name:CACACE
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2216
Mailing Address - Country:US
Mailing Address - Phone:718-980-1700
Mailing Address - Fax:718-980-1777
Practice Address - Street 1:348 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2216
Practice Address - Country:US
Practice Address - Phone:718-980-1700
Practice Address - Fax:718-980-1777
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist