Provider Demographics
NPI:1619346657
Name:PASSARETTI, TARA (NCC,LMHC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:PASSARETTI
Suffix:
Gender:F
Credentials:NCC,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17890 NE 31ST CT
Mailing Address - Street 2:APT. 3319
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5019
Mailing Address - Country:US
Mailing Address - Phone:954-540-4130
Mailing Address - Fax:
Practice Address - Street 1:20801 BISCAYNE BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1430
Practice Address - Country:US
Practice Address - Phone:786-671-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 14552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health