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General NPI Number Information
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NPI Number | 1114445244
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Entity Type | Individual
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Provider Name | TARYN HEATH
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Gender | Female
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Dates
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Enumeration Date | 09/09/2017
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Last Update Date | 09/09/2017
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Provider Practice Location Address
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Address Line | 620 WASHINGTON AVE
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City | RENSSELAER
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State | NY
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Zip | 12144-1300
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Country | US
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Telephone | 607-591-0528
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Fax |
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Provider Business Mailing Address
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Address Line | 4301 STONEGATE DR
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City | RENSSELAER
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State | NY
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Zip | 12144-8305
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Country | US
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Telephone | 607-591-0528
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | P07671
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License Number State | NY
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