| NPI | 1164959854 |
|---|---|
| Former Name | TIARA ANNETTE FORMARO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 15005) |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2017-05-12 |