Provider Demographics
NPI:1770864498
Name:STAVER, TARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:STAVER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:MARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1419 CLIFTON ST NW
Mailing Address - Street 2:#203
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4557
Mailing Address - Country:US
Mailing Address - Phone:202-445-4700
Mailing Address - Fax:
Practice Address - Street 1:1419 CLIFTON ST NW
Practice Address - Street 2:#203
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4557
Practice Address - Country:US
Practice Address - Phone:202-445-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04881103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical