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General NPI Number Information
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NPI Number | 1235779455
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Entity Type | Individual
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Provider Name | TARA GANS MA, MFT
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Gender | Female
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Dates
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Enumeration Date | 01/15/2020
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 116 MILE COMMON RD
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City | EASTON
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State | CT
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Zip | 06612-1506
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Country | US
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Telephone | 203-916-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 17 SHERWOOD FARMS
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City | WESTPORT
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State | CT
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Zip | 06880-6155
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Country | US
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Telephone | 203-349-5902
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2282
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License Number State | CT
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