Provider Demographics
NPI:1962637637
Name:MONTEMURRO, TARA (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MONTEMURRO
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:EDMONSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA, LBA
Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-0586
Mailing Address - Country:US
Mailing Address - Phone:845-673-5636
Mailing Address - Fax:
Practice Address - Street 1:2250 GOSHEN TPKE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4031
Practice Address - Country:US
Practice Address - Phone:845-673-5636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-23
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY841964174400000X
NY363103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist