Provider Demographics
NPI:1467153189
Name:PIERCE, TARA M (LISW-S)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19660 S SAGAMORE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-1655
Mailing Address - Country:US
Mailing Address - Phone:216-832-1117
Mailing Address - Fax:
Practice Address - Street 1:19660 S SAGAMORE RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-1655
Practice Address - Country:US
Practice Address - Phone:216-832-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.11012421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical