Provider Demographics
NPI:1184921611
Name:PEARLMAN, TARA ELIZABETH (MSCCC-SLP, TSHH)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ELIZABETH
Last Name:PEARLMAN
Suffix:
Gender:F
Credentials:MSCCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 COUNTY ROUTE 50
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958-3503
Mailing Address - Country:US
Mailing Address - Phone:845-468-5734
Mailing Address - Fax:
Practice Address - Street 1:379 MT HOPE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-7135
Practice Address - Country:US
Practice Address - Phone:845-344-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015841-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist