Provider Demographics
NPI:1215212311
Name:FERRARA, TARA (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:TARA
Middle Name:
Last Name:FERRARA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E 53RD ST
Mailing Address - Street 2:APT 403
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4667
Mailing Address - Country:US
Mailing Address - Phone:516-286-4829
Mailing Address - Fax:
Practice Address - Street 1:250 E 53RD ST
Practice Address - Street 2:APT 403
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4667
Practice Address - Country:US
Practice Address - Phone:516-286-4829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020975235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist