Provider Demographics
NPI:1376251108
Name:KEPHART, TARA (LSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:KEPHART
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 ERDLEY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17889-8894
Mailing Address - Country:US
Mailing Address - Phone:814-762-4752
Mailing Address - Fax:
Practice Address - Street 1:1372 N SUSQUEHANNA TRL STE 330
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-8974
Practice Address - Country:US
Practice Address - Phone:570-743-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138831104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker