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NPI Code Detail

MEDICARE: MARK A TARANGIOLI PSY.D. LLC

MEDICARE: MARK A TARANGIOLI PSY.D. LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist002418CT
2103TC0700XClinical Psychologist35SI00448000NJ

General Provider Information

NPI Number : 1609974336
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK A TARANGIOLI PSY.D. LLC
Provider Business Mailing Address
First Line : 3804 CHURCH RD
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-1106
Country : US
Telephone Number : 856-761-4823
Fax Number :
Provider Business Practice Location Address
First Line : 3804 CHURCH RD
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-1106
Country : US
Telephone Number : 856-761-4823
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 12/31/2014

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