Provider Demographics
NPI:1508496878
Name:WINTER-DIGIROLAMO, TARA (LCAT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:WINTER-DIGIROLAMO
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:WINTER-DIGIROLAMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAT, RDT, RYT
Mailing Address - Street 1:2 OLIVE LN
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-3332
Mailing Address - Country:US
Mailing Address - Phone:347-263-4582
Mailing Address - Fax:
Practice Address - Street 1:873 ROUTE 35
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518-1143
Practice Address - Country:US
Practice Address - Phone:347-263-4582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001602101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001602Medicaid