Provider Demographics
NPI:1558577361
Name:BARROS, TANYA (LMHC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:BARROS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CARMAN AVE
Mailing Address - Street 2:CORE BUILDING MH CLINIC
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 CARMAN AVE
Practice Address - Street 2:CORE BUILDING MH CLINIC
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1160
Practice Address - Country:US
Practice Address - Phone:516-572-3933
Practice Address - Fax:516-572-3433
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002454-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health