Provider Demographics
NPI:1417335365
Name:TAMAR PORT COUNSELING LLC
Entity Type:Organization
Organization Name:TAMAR PORT COUNSELING LLC
Other - Org Name:TAMAR J PORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMAR
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:PORT
Authorized Official - Suffix:
Authorized Official - Credentials:MSS
Authorized Official - Phone:215-530-2564
Mailing Address - Street 1:826 VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1639
Mailing Address - Country:US
Mailing Address - Phone:215-530-2564
Mailing Address - Fax:215-646-5253
Practice Address - Street 1:826 VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1639
Practice Address - Country:US
Practice Address - Phone:215-530-2564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000153L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA645595Medicare PIN