Tara M. Boadu, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY003163 Issued in GA

Practice address

4530 S Berkeley Lake Rd
Suite B
Norcross, GA 30071-1660

Phone

(770) 417-2724

Fax

(770) 446-5643

NPI assigned

Sep 23, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tara M. Boadu, Psy.D. LLC

  • Clinical Psychologist
  • Berkeley Lake, GA
  • NPI 1114316395
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222128000000",
    "number": "1497905863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 S BERKELEY LAKE RD",
            "address_2": "SUITE B",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300711660",
            "telephone_number": "770-417-2724",
            "fax_number": "770-446-5643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 S BERKELEY LAKE RD",
            "address_2": "SUITE B",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300711660",
            "telephone_number": "770-417-2724",
            "fax_number": "770-446-5643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOADU",
        "first_name": "TARA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-23",
        "last_updated": "2008-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Christina Andria Boland, RBT
• Erica Chanise Bolar, DNP, FNP, CARN-AP

• Clinical Psychologist in Norcross, GA
• Providers in Norcross, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.