Provider Demographics
NPI:1932865482
Name:TANGRADI, MEGAN (MS, LAC, LCADC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:TANGRADI
Suffix:
Gender:F
Credentials:MS, LAC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 TILTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1253
Mailing Address - Country:US
Mailing Address - Phone:856-340-0940
Mailing Address - Fax:
Practice Address - Street 1:333 TILTON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1253
Practice Address - Country:US
Practice Address - Phone:848-209-6482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00521600101YM0800X
NJ37LC00340100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health