Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY 4860 | FL |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY 4860 | FL |
Y | 103G00000X | Clinical Psychologist | PY 4860 | FL |
Y | 103TC0700X | Clinical Psychologist | PY 4860 | FL |
NPI | 1033403548 |
---|---|
Provider Name | Louis William Tarasi |
First Address | Camp Lejeune, NC 28547-2538 |
Second Address | Camp Lejeune, NC 28547-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2011 |
Last Update Date | 25/10/2011 |