Provider Demographics
NPI:1083433122
Name:TOAL-FLYNN, TARA ASHLEY
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ASHLEY
Last Name:TOAL-FLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ASHELY
Other - Last Name:TOAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-4572
Mailing Address - Country:US
Mailing Address - Phone:856-449-1787
Mailing Address - Fax:
Practice Address - Street 1:1930 ROUTE 70 E STE I48
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-4105
Practice Address - Country:US
Practice Address - Phone:856-435-6023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician