Individual
TARA RENEE GAMBLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
466 MAIN ST # LL20, NEW ROCHELLE, NY 10801-6431
(914) 863-4503
Mailing address
466 MAIN ST # LL20, NEW ROCHELLE, NY 10801-6431
(914) 863-4503
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106S0000X
BEHAVIORAL HEALTH
—
Enumeration date
03/09/2020
Last updated
03/09/2020
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