Provider Demographics
NPI:1710558143
Name:CASIMANO, TARA LOONEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LOONEY
Last Name:CASIMANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 MCCORD AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4229
Mailing Address - Country:US
Mailing Address - Phone:917-902-4333
Mailing Address - Fax:
Practice Address - Street 1:82 MCCORD AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4229
Practice Address - Country:US
Practice Address - Phone:917-902-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005590-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist