Provider Demographics
NPI:1548881352
Name:TARLOW, KEVIN RAYMOND (PHD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RAYMOND
Last Name:TARLOW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 RIVERSIDE DR APT 6C
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3643
Mailing Address - Country:US
Mailing Address - Phone:512-426-4138
Mailing Address - Fax:
Practice Address - Street 1:2000 RIVERSIDE DRIVE
Practice Address - Street 2:APT. 6C
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225
Practice Address - Country:US
Practice Address - Phone:512-426-4138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38469103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist