Provider Demographics
NPI:1962835736
Name:SINES, TARA ANN (MS, BCBA, LBS)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:ANN
Last Name:SINES
Suffix:
Gender:F
Credentials:MS, BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-2043
Mailing Address - Country:US
Mailing Address - Phone:267-285-3288
Mailing Address - Fax:
Practice Address - Street 1:281 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19054-2043
Practice Address - Country:US
Practice Address - Phone:267-285-3288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003453103K00000X
PA1-13-13968103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1-13-13968OtherBEHAVIOR ANALYST CERTIFICATION BOARD
PA147310OtherDEPARTMENT OF HUMAN SERVICES- INTENSIVE BEHAVIOR HEALTH SERVICES LICENSE
PABH003453OtherSTATE BOARD OF MEDICINE
PA1038553590001Medicaid