Provider Demographics
NPI:1477959989
Name:GREENE-MINETT, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:GREENE-MINETT
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 1:4900 PERRY HWY
Mailing Address - Street 2:BUILDING 2 SUITE 200
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229
Mailing Address - Country:US
Mailing Address - Phone:724-850-8118
Mailing Address - Fax:724-850-9500
Practice Address - Street 1:4900 PERRY HWY
Practice Address - Street 2:BUILDING 2 SUITE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15229
Practice Address - Country:US
Practice Address - Phone:724-850-8118
Practice Address - Fax:724-850-9500
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017670103T00000X, 103TC2200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool