Provider Demographics
NPI:1528653714
Name:TARANTELLA, ANDREA ROSE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ROSE
Last Name:TARANTELLA
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 1:926 HURON AVE
Mailing Address - Street 2:
Mailing Address - City:RENOVO
Mailing Address - State:PA
Mailing Address - Zip Code:17764-1142
Mailing Address - Country:US
Mailing Address - Phone:570-660-8171
Mailing Address - Fax:
Practice Address - Street 1:926 HURON AVE
Practice Address - Street 2:
Practice Address - City:RENOVO
Practice Address - State:PA
Practice Address - Zip Code:17764-1142
Practice Address - Country:US
Practice Address - Phone:570-660-8171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional