Provider Demographics
NPI:1619058666
Name:STABLEIN, TARA MAY (MSW)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:MAY
Last Name:STABLEIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S. COLUMBIAN WAY
Mailing Address - Street 2:MAILSTOP S-122-SW
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108
Mailing Address - Country:US
Mailing Address - Phone:206-277-6696
Mailing Address - Fax:206-764-2514
Practice Address - Street 1:1660 S. COLUMBIAN WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108
Practice Address - Country:US
Practice Address - Phone:206-277-6696
Practice Address - Fax:206-764-2263
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000077641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical