Provider Demographics
NPI:1780969220
Name:PASCIUCCO, TARA MARIE (LCAT, ATR-BC, CASAC)
Entity type:Individual
Prefix:MISS
First Name:TARA
Middle Name:MARIE
Last Name:PASCIUCCO
Suffix:
Gender:F
Credentials:LCAT, ATR-BC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PARK AVE
Mailing Address - Street 2:SMITHERS ADDICTION CENTER
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-3402
Mailing Address - Country:US
Mailing Address - Phone:914-964-7814
Mailing Address - Fax:914-964-7840
Practice Address - Street 1:2 PARK AVE
Practice Address - Street 2:SMITHERS ADDICTION CENTER
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-3402
Practice Address - Country:US
Practice Address - Phone:914-964-7814
Practice Address - Fax:914-964-7840
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24438101YA0400X
11-157101YM0800X
NY001269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health