Provider Demographics
NPI:1528851177
Name:BOSS, TARA (BA SP ED)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BOSS
Suffix:
Gender:F
Credentials:BA SP ED
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:LAROCCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA SP ED
Mailing Address - Street 1:12 KEATOR RD
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-3942
Mailing Address - Country:US
Mailing Address - Phone:845-674-0949
Mailing Address - Fax:
Practice Address - Street 1:12 KEATOR RD
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-3942
Practice Address - Country:US
Practice Address - Phone:845-674-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist