Provider Demographics
NPI:1528391737
Name:MATHEWS, TARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DIVISION OF CHILD AND ADOLESCENT PSYCHIATRY
Mailing Address - Street 2:600 N. WOLFE STREET/ CMSC 376
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0001
Mailing Address - Country:US
Mailing Address - Phone:410-955-3140
Mailing Address - Fax:410-955-8691
Practice Address - Street 1:DIVISION OF CHILD AND ADOLESCENT PSYCHIATRY
Practice Address - Street 2:600 N. WOLFE STREET/ CMSC 376
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:410-955-3140
Practice Address - Fax:410-955-8691
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23455103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent