Provider Demographics
NPI:1295171379
Name:BUFFOLINO, TARYN M (LPC)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:M
Last Name:BUFFOLINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:M
Other - Last Name:KAVANAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 TALL TREE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2925
Mailing Address - Country:US
Mailing Address - Phone:732-672-4791
Mailing Address - Fax:
Practice Address - Street 1:41 TALL TREE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748
Practice Address - Country:US
Practice Address - Phone:732-672-4791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00474400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional