Provider Demographics
NPI:1568225498
Name:TAM, RHODA
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:
Last Name:TAM
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 1:2909 137TH ST APT 1G
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2001
Mailing Address - Country:US
Mailing Address - Phone:917-907-1873
Mailing Address - Fax:
Practice Address - Street 1:2511 UNION ST APT 6D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1264
Practice Address - Country:US
Practice Address - Phone:646-204-5999
Practice Address - Fax:917-563-5177
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002784-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst