MEDICARE: MISS EVA TARNAWSKI M.A.

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
1	106H00000X	Marriage & Family Therapist	001190	CT

General Provider Information

NPI Number	:	1821376856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EVA TARNAWSKI M.A.

Provider Business Mailing Address
First Line	:	185 VILLAGE SQUARE DR APT 33
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06053-1236
Country	:	US
Telephone Number	:	860-916-1621
Fax Number	:

Provider Business Practice Location Address
First Line	:	1738 ELLINGTON RD
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-2773
Country	:	US
Telephone Number	:	860-916-1621
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	07/25/2011

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