Active NPI
Tara Iris Mims, M.S.
- Behavior Analyst
- Valley Stream, NY
National Provider Identifier
1467036863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 100 Gibson Blvd
Valley Stream, NY 11581-3376 - Phone
- (212) 444-8881
- Fax
- (914) 229-2022
- NPI assigned
- May 11, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | NY | Primary |
Addresses
Primary practice location
100 Gibson Blvd
Valley Stream, NY 11581-3376
Mailing address
391 E 149TH St RM 417
Bronx, NY 10455-3907
Phone (646) 702-6965
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620691200000",
"number": "1467036863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "391 E 149TH ST RM 417",
"city": "BRONX",
"state": "NY",
"postal_code": "104553907",
"telephone_number": "646-702-6965",
"fax_number": "914-229-2022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 GIBSON BLVD",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115813376",
"telephone_number": "212-444-8881",
"fax_number": "914-229-2022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIMS",
"first_name": "TARA",
"middle_name": "IRIS",
"name_prefix": "Ms.",
"credential": "M.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-11",
"last_updated": "2021-05-11",
"certification_date": "2021-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NY",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valley Stream, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.