Provider Demographics
NPI:1124650494
Name:TARA L. MONTEMURRO, LICENSED BEHAVIOR ANALYST, P.C
Entity type:Organization
Organization Name:TARA L. MONTEMURRO, LICENSED BEHAVIOR ANALYST, P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTEMURRO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LBA, BCBA
Authorized Official - Phone:845-673-5636
Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-0586
Mailing Address - Country:US
Mailing Address - Phone:845-673-5636
Mailing Address - Fax:844-760-0153
Practice Address - Street 1:2250 GOSHEN TPKE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4031
Practice Address - Country:US
Practice Address - Phone:845-673-5636
Practice Address - Fax:844-760-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency