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General NPI Number Information
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NPI Number | 1881065993
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Entity Type | Individual
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Provider Name | TARA CRYDERMAN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 1156 HIGH ST
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City | SANTA CRUZ
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State | CA
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Zip | 95064-1077
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Country | US
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Telephone | 408-899-0646
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Fax |
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Provider Business Mailing Address
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Address Line | 23 DUNSLEE WAY
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City | SCOTTS VALLEY
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State | CA
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Zip | 95066-3427
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Country | US
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Telephone |
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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 | 82992
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 29324
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License Number State | CA
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