Provider Demographics
NPI:1902665110
Name:TAMARASA THERAPY PLLC
Entity type:Organization
Organization Name:TAMARASA THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANU
Authorized Official - Middle Name:
Authorized Official - Last Name:MENON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LICSW
Authorized Official - Phone:919-228-9587
Mailing Address - Street 1:6 CONSULTANT PL STE 100B
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3598
Mailing Address - Country:US
Mailing Address - Phone:919-228-8455
Mailing Address - Fax:
Practice Address - Street 1:6 CONSULTANT PL STE 100B
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3598
Practice Address - Country:US
Practice Address - Phone:919-228-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health