Provider Demographics
NPI:1104128131
Name:MARDER, TAMARA JILL (PHD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:JILL
Last Name:MARDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 SPRING HILL RD
Mailing Address - Street 2:3RD FL, SUITE 310
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-7510
Mailing Address - Country:US
Mailing Address - Phone:703-585-1095
Mailing Address - Fax:
Practice Address - Street 1:1604 SPRING HILL RD
Practice Address - Street 2:3RD FL, SUITE 310
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-7510
Practice Address - Country:US
Practice Address - Phone:703-585-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-07-3304103K00000X
DCPSY1000529103T00000X
MD04031103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist