Provider Demographics
NPI:1558631614
Name:TARRANT, MARYBETH
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:TARRANT
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 1:500 BROADWAY
Mailing Address - Street 2:JFK MIDDLE SCHOOL
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714
Mailing Address - Country:US
Mailing Address - Phone:516-644-4228
Mailing Address - Fax:516-937-0540
Practice Address - Street 1:500 BROADWAY
Practice Address - Street 2:JFK MIDDLE SCHOOL
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-2203
Practice Address - Country:US
Practice Address - Phone:516-644-4228
Practice Address - Fax:516-937-0540
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039404-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool