Provider Demographics
NPI:1598246225
Name:BRIERLEY, TARA VICTORIA (LCSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:VICTORIA
Last Name:BRIERLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:VICTORIA
Other - Last Name:BUTRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:375 MATHER ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-3101
Mailing Address - Country:US
Mailing Address - Phone:203-671-7662
Mailing Address - Fax:
Practice Address - Street 1:14 SYCAMORE WAY
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-6551
Practice Address - Country:US
Practice Address - Phone:203-483-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4356104100000X
CT110351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker