Provider Demographics
NPI:1275068470
Name:AUGENSTEIN, TARA MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:AUGENSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF ROCHESTER, DEPT. OF PSYCHIATRY
Mailing Address - Street 2:300 CRITTENDEN BLVD
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642
Mailing Address - Country:US
Mailing Address - Phone:585-276-7101
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF ROCHESTER, DEPT. OF PSYCHIATRY
Practice Address - Street 2:300 CRITTENDEN BLVD
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642
Practice Address - Country:US
Practice Address - Phone:585-276-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23282103TC0700X
MA390200000X
NY023282103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program