Provider Demographics
NPI:1770736993
Name:ANDERSON, TARA LETITIA
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:LETITIA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 OCEAN AVE
Mailing Address - Street 2:APT. D1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1759
Mailing Address - Country:US
Mailing Address - Phone:917-553-3783
Mailing Address - Fax:
Practice Address - Street 1:3312 SURF AVENUE
Practice Address - Street 2:JBFCS
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224
Practice Address - Country:US
Practice Address - Phone:718-372-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health