Provider Demographics
NPI:1790144699
Name:MCBRIDE, TARA (BCBA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 FAIR ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-1310
Mailing Address - Country:US
Mailing Address - Phone:845-705-5027
Mailing Address - Fax:
Practice Address - Street 1:83 FAIR ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-1310
Practice Address - Country:US
Practice Address - Phone:845-705-5027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NY305678988174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst