Provider Demographics
NPI:1841504891
Name:RICAFORTE, TAMARA ANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANNE
Last Name:RICAFORTE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E 22ND ST
Mailing Address - Street 2:APT. 16S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5315
Mailing Address - Country:US
Mailing Address - Phone:203-520-1084
Mailing Address - Fax:
Practice Address - Street 1:5 E 22ND ST
Practice Address - Street 2:APT. 16S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5315
Practice Address - Country:US
Practice Address - Phone:203-520-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0155081171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor