Provider Demographics
NPI:1821331588
Name:NOLAN, TARA LEE (MSED, ACS, LMHC,)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:LEE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MSED, ACS, LMHC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 WINTON ROAD SOUTH
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-613-6929
Mailing Address - Fax:
Practice Address - Street 1:919 WINTON RD S
Practice Address - Street 2:SUITE 305
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1633
Practice Address - Country:US
Practice Address - Phone:585-613-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005317-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health