Provider Demographics
NPI:1346826567
Name:AMOR, TARA A
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:A
Last Name:AMOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 PERIDOT DR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3982
Mailing Address - Country:US
Mailing Address - Phone:703-944-3888
Mailing Address - Fax:
Practice Address - Street 1:8215 PERIDOT DR UNIT 103
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3982
Practice Address - Country:US
Practice Address - Phone:703-944-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician