Provider Demographics
NPI:1679828107
Name:CARDENAS, TARA (M ED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:M ED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1830
Mailing Address - Country:US
Mailing Address - Phone:917-725-1779
Mailing Address - Fax:
Practice Address - Street 1:79 WALKER ST
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1830
Practice Address - Country:US
Practice Address - Phone:917-627-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000437-01103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst