Individual provider Active NPI

Tania Liseth Ulloa

  • Mental Health Counselor
  • Forest Hills, NY
National Provider Identifier
1629640347
Registry record updated Nov 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
11835 Queens Blvd Ste 400
Forest Hills, NY 11375-7211
Phone
(646) 656-0164
Fax
(718) 520-7612
NPI assigned
Jul 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary
Case Manager/Care Coordinator 171M00000X NY

Addresses

Primary practice location

11835 Queens Blvd Ste 400
Forest Hills, NY 11375-7211

Mailing address

8 Dawson PL
Huntington Station, NY 11746-1002
Phone (631) 575-0822

Other practice location 1

225 Broadhollow Rd Ste 402
Melville, NY 11747-4899
Phone (631) 385-7780

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

NPI Registry JSON

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

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762300800000",
    "number": "1629640347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 DAWSON PL",
            "city": "HUNTINGTON STATION",
            "state": "NY",
            "postal_code": "117461002",
            "telephone_number": "631-575-0822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11835 QUEENS BLVD STE 400",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757211",
            "telephone_number": "646-656-0164",
            "fax_number": "718-520-7612"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 Broadhollow Rd Ste 402",
            "address_purpose": "LOCATION",
            "city": "Melville",
            "state": "NY",
            "postal_code": "117474899",
            "country_code": "US",
            "telephone_number": "631-385-7780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ULLOA",
        "first_name": "TANIA",
        "middle_name": "LISETH",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-13",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.