Provider Demographics
NPI:1578964995
Name:BREITSPRECHER, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BREITSPRECHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PHEASANT CT
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4367
Mailing Address - Country:US
Mailing Address - Phone:860-402-6404
Mailing Address - Fax:
Practice Address - Street 1:12 PHEASANT CT
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4367
Practice Address - Country:US
Practice Address - Phone:860-402-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131495104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker