Provider Demographics
NPI:1457819617
Name:TAGARIELLO, EMMA COLEEN
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:COLEEN
Last Name:TAGARIELLO
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 1:28 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1735
Mailing Address - Country:US
Mailing Address - Phone:862-217-1363
Mailing Address - Fax:
Practice Address - Street 1:170 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1220
Practice Address - Country:US
Practice Address - Phone:973-593-3117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health