Provider Demographics
NPI:1578900494
Name:KAREN, TARA (BCBA)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:KAREN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MUSKET PL
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1828
Mailing Address - Country:US
Mailing Address - Phone:631-827-5227
Mailing Address - Fax:
Practice Address - Street 1:10 MUSKET PL
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1828
Practice Address - Country:US
Practice Address - Phone:631-827-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-01
Last Update Date:2013-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-13-12862103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst