Provider Demographics
NPI:1639703630
Name:DUFFY, TARA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:MARIE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:MARIE
Other - Last Name:CHRISTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-0639
Mailing Address - Country:US
Mailing Address - Phone:267-405-3229
Mailing Address - Fax:
Practice Address - Street 1:201 KING OF PRUSSIA RD STE 650
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5156
Practice Address - Country:US
Practice Address - Phone:267-405-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0185781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical