Provider Demographics
NPI:1992761175
Name:VAN TASSEL, TARA E (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:E
Last Name:VAN TASSEL
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:E
Other - Last Name:PARISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:2 MEADER ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-3223
Mailing Address - Country:US
Mailing Address - Phone:401-331-1350
Mailing Address - Fax:
Practice Address - Street 1:55 HOPE ST
Practice Address - Street 2:C/O FAMILY SERVICE OF RHODE ISLAND, INC
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2001
Practice Address - Country:US
Practice Address - Phone:401-331-1350
Practice Address - Fax:401-277-3366
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RITP47687Medicaid