Provider Demographics
NPI:1679933691
Name:CORN, TARA BETH (LMSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:BETH
Last Name:CORN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4311
Mailing Address - Country:US
Mailing Address - Phone:516-551-8859
Mailing Address - Fax:
Practice Address - Street 1:506 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4706
Practice Address - Country:US
Practice Address - Phone:516-705-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker