Provider Demographics
NPI:1346648169
Name:KARCZEWSKI-MITCHELL, TARA (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:KARCZEWSKI-MITCHELL
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:KARCZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 CALDWELL RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5735
Practice Address - Country:US
Practice Address - Phone:207-626-3448
Practice Address - Fax:207-621-6228
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC14867104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker