Provider Demographics
NPI:1720145055
Name:MCAVOY, TARA (MA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MCAVOY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-4909
Mailing Address - Country:US
Mailing Address - Phone:207-242-5778
Mailing Address - Fax:
Practice Address - Street 1:144 HIGH ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-1946
Practice Address - Country:US
Practice Address - Phone:207-778-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3696101YM0800X
MA6977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health