Provider Demographics
NPI:1275546517
Name:LOUCHERY, TARA (DED)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:LOUCHERY
Suffix:
Gender:F
Credentials:DED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 S POTOMAC ST
Mailing Address - Street 2:#2R
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6194
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28 S POTOMAC ST
Practice Address - Street 2:#2R
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6194
Practice Address - Country:US
Practice Address - Phone:301-331-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS01631103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
L01866259OtherBLUE SHIELD
PA101644023Medicaid