Provider Demographics
NPI:1407151806
Name:WEBSTER, TARA LEIGH (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LEIGH
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LEIGH
Other - Last Name:CLENDANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LGSW
Mailing Address - Street 1:2336 GODDARD PKWY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1126
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6362
Practice Address - Street 1:2336 GODDARD PKWY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-1126
Practice Address - Country:US
Practice Address - Phone:410-334-6961
Practice Address - Fax:410-334-6362
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19058104100000X, 1041C0700X
MDSC1659101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD259147-000OtherMAGELLAN BEHAVIORAL HEALTH
MD517251OtherOPTUM/UBH
MD346646OtherMHN/TRICARE
MD7840093.OtherAETNA
MD520202700Medicaid
MDR968OtherCAREFIRST
MD609550001Medicaid
MD517251OtherOPTUM/UBH