Provider Demographics
NPI:1538442140
Name:CHALAKANI, TARA A (RN, MS, NCC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:A
Last Name:CHALAKANI
Suffix:
Gender:F
Credentials:RN, MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1545
Mailing Address - Country:US
Mailing Address - Phone:908-914-2049
Mailing Address - Fax:
Practice Address - Street 1:620 SHORE RD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-1854
Practice Address - Country:US
Practice Address - Phone:732-974-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10714600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health