Provider Demographics
NPI:1740665769
Name:STUDLEY, TARA MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:MICHELLE
Last Name:STUDLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N JACKSON ST STE 306
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2530
Mailing Address - Country:US
Mailing Address - Phone:570-259-6496
Mailing Address - Fax:
Practice Address - Street 1:600 N JACKSON ST STE 306
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2530
Practice Address - Country:US
Practice Address - Phone:484-440-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
PAPS019447103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool