Healthcare Provider Details

I. General information

NPI: 1538483193
Provider Name (Legal Business Name): MRS. ANGELA MARIE TATAREK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S ARCH ST
CONNELLSVILLE PA
15425-3515
US

IV. Provider business mailing address

216 WREN DR
GREENSBURG PA
15601-4741
US

V. Phone/Fax

Practice location:
  • Phone: 724-626-9941
  • Fax: 724-626-2785
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF000589
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: