Provider Demographics
NPI:1487263281
Name:BURGESS, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:BURGESS
Other - Last Name:EDELMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:357 NASHAWTUC RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-1616
Mailing Address - Country:US
Mailing Address - Phone:339-201-1765
Mailing Address - Fax:
Practice Address - Street 1:357 NASHAWTUC RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1616
Practice Address - Country:US
Practice Address - Phone:339-201-1765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health