Provider Demographics
NPI:1376424895
Name:OPPENHEIMER, TARA DAWN
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:DAWN
Last Name:OPPENHEIMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 WHISTLING MOON LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2622
Mailing Address - Country:US
Mailing Address - Phone:505-429-6770
Mailing Address - Fax:
Practice Address - Street 1:4312 WHISTLING MOON LN
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2622
Practice Address - Country:US
Practice Address - Phone:505-429-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1-18-32593103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst