MEDICARE: DR. ALLEN JOSEPH TAMAREN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	01226	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01226	OTHER	MO	PSYCHOLOGY LICENSE

General Provider Information

NPI Number	:	1356553853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN JOSEPH TAMAREN PHD

Provider Business Mailing Address
First Line	:	4 RUI VISTA
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63124-1745
Country	:	US
Telephone Number	:	314-863-7228
Fax Number	:	314-863-7228

Provider Business Practice Location Address
First Line	:	4 RIO VISTA
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63124-1745
Country	:	US
Telephone Number	:	314-863-7228
Fax Number	:	314-863-7228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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