Provider Demographics
NPI:1194547711
Name:GARCIA TARANTO, MARIA V
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:V
Last Name:GARCIA TARANTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 THREE CHOPT ROAD
Mailing Address - Street 2:SUITE 143
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4833
Mailing Address - Country:US
Mailing Address - Phone:804-269-4732
Mailing Address - Fax:
Practice Address - Street 1:8100 THREE CHOPT ROAD
Practice Address - Street 2:SUITE 143
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-4833
Practice Address - Country:US
Practice Address - Phone:804-269-4732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-335941106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265EMedicaid