Provider Demographics
NPI:1841305778
Name:TARNELL, ANTONIETTA
Entity type:Individual
Prefix:
First Name:ANTONIETTA
Middle Name:
Last Name:TARNELL
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 1:91 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2810
Mailing Address - Country:US
Mailing Address - Phone:914-244-9400
Mailing Address - Fax:800-275-3671
Practice Address - Street 1:91 SMITH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2810
Practice Address - Country:US
Practice Address - Phone:914-244-9400
Practice Address - Fax:800-275-3671
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016101103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical