Provider Demographics
NPI:1992402812
Name:TARTARO, DENA (LSW)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:TARTARO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:
Other - Last Name:RAPHAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1681
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-6681
Mailing Address - Country:US
Mailing Address - Phone:609-335-2656
Mailing Address - Fax:
Practice Address - Street 1:10 E NEW YORK AVE STE 1
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2367
Practice Address - Country:US
Practice Address - Phone:609-788-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06787000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker