Provider Demographics
NPI:1124808183
Name:DORGAN, TARA (MA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:DORGAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3436 FITLER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2609
Mailing Address - Country:US
Mailing Address - Phone:609-477-4934
Mailing Address - Fax:
Practice Address - Street 1:3436 FITLER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2609
Practice Address - Country:US
Practice Address - Phone:609-477-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health