MEDICARE: TARA SINES

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1891188462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARA SINES

Provider Business Mailing Address
First Line	:	3206 LONGSHORE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2024
Country	:	US
Telephone Number	:	267-285-3288
Fax Number	:

Provider Business Practice Location Address
First Line	:	3206 LONGSHORE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2024
Country	:	US
Telephone Number	:	267-285-3288
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	TARA ANN SINES
Credential	:	M.S., BCBA
Telephone Number	:	267-285-3288

Provider Enumeration Date	:	03/06/2015
Last Update Date	:	03/06/2015

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