Provider Demographics
NPI:1922294412
Name:TARASUK, PENELOPE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:A
Last Name:TARASUK
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 1:8 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-1128
Mailing Address - Country:US
Mailing Address - Phone:413-665-2361
Mailing Address - Fax:
Practice Address - Street 1:8 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-1128
Practice Address - Country:US
Practice Address - Phone:413-665-2361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000315102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst