| Tara M. Boadu, Psy.d. Llc | |
|
4530 S Berkeley Lake Rd Suite B Berkeley Lake GA 30071-1660 | |
| (470) 514-3727 | |
| (770) 446-5643 |
| Full Name | Tara M. Boadu, Psy.d. Llc |
|---|---|
| Speciality | Psychologist |
| Location | 4530 S Berkeley Lake Rd, Berkeley Lake, Georgia |
| Authorized Official Name and Position | Tara M Boadu (PSYCHOLOGIST) |
| Authorized Official Contact | 6786434495 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tara M. Boadu, Psy.d. Llc 4530 S Berkeley Lake Rd Suite B Berkeley Lake GA 30071-1660 Ph: (470) 514-3727 | Tara M. Boadu, Psy.d. Llc 4530 S Berkeley Lake Rd Suite B Berkeley Lake GA 30071-1660 Ph: (470) 514-3727 |
| NPI Number | 1114316395 |
|---|---|
| Provider Enumeration Date | 01/12/2015 |
| Last Update Date | 01/12/2015 |
| Medicare PECOS PAC ID | 3072826858 |
|---|---|
| Medicare Enrollment ID | O20150722006052 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114316395 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY003163 (Georgia) | Primary |
| Provider Name | Tara M Boadu |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497905863 PECOS PAC ID: 1153557921 Enrollment ID: I20131127000189 |
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