Provider Demographics
NPI:1972346781
Name:PEREZ-GALAN, TARAH HANNA
Entity type:Individual
Prefix:
First Name:TARAH HANNA
Middle Name:
Last Name:PEREZ-GALAN
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 1:8635 QUEENS BLVD APT 4U
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4414
Mailing Address - Country:US
Mailing Address - Phone:646-479-6697
Mailing Address - Fax:
Practice Address - Street 1:8635 QUEENS BLVD APT 4U
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4414
Practice Address - Country:US
Practice Address - Phone:646-479-6697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012724101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health