Provider Demographics
NPI:1659498103
Name:TARTER, MILES (PSYD)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:TARTER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-1542
Mailing Address - Country:US
Mailing Address - Phone:617-877-5978
Mailing Address - Fax:206-666-3687
Practice Address - Street 1:875 MASSACHUSETTS AVE STE 83
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3071
Practice Address - Country:US
Practice Address - Phone:617-877-5978
Practice Address - Fax:206-666-3687
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical