Healthcare Provider Details

I. General information

NPI: 1275934606
Provider Name (Legal Business Name): TARA QUINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S MAIN ST
CHAGRIN FALLS OH
44022-3225
US

IV. Provider business mailing address

2773 FROST RD
MANTUA OH
44255-9485
US

V. Phone/Fax

Practice location:
  • Phone: 216-232-3098
  • Fax:
Mailing address:
  • Phone: 216-571-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberOH3133490
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: