Provider Demographics
NPI:1043071731
Name:WHITE TARA THERAPY LLC
Entity type:Organization
Organization Name:WHITE TARA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZUCKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-741-8898
Mailing Address - Street 1:45 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:ELDRED
Mailing Address - State:NY
Mailing Address - Zip Code:12732-5012
Mailing Address - Country:US
Mailing Address - Phone:845-741-8898
Mailing Address - Fax:
Practice Address - Street 1:45 CLARK RD
Practice Address - Street 2:
Practice Address - City:ELDRED
Practice Address - State:NY
Practice Address - Zip Code:12732-5012
Practice Address - Country:US
Practice Address - Phone:845-741-8898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center