Provider Demographics
NPI:1902349426
Name:RONDEAU, TARA (MS, LCDP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:RONDEAU
Suffix:
Gender:F
Credentials:MS, LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 S COUNTY COMMONS WAY
Mailing Address - Street 2:UNIT 49 F6
Mailing Address - City:SOUTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02879-8269
Mailing Address - Country:US
Mailing Address - Phone:401-783-2220
Mailing Address - Fax:401-783-2224
Practice Address - Street 1:49 S COUNTY COMMONS WAY
Practice Address - Street 2:UNIT 49 F6
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-8269
Practice Address - Country:US
Practice Address - Phone:401-783-2220
Practice Address - Fax:401-783-2224
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
RICDP00773101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICDP00773OtherSTATE OF RI