Provider Demographics
NPI:1396376844
Name:ALHADEFF, TARA MICHELLE (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:MICHELLE
Last Name:ALHADEFF
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N BAYSHORE DR APT 3606
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5176
Mailing Address - Country:US
Mailing Address - Phone:305-502-2633
Mailing Address - Fax:
Practice Address - Street 1:8301 W MCNAB RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-3206
Practice Address - Country:US
Practice Address - Phone:305-502-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health