Provider Demographics
NPI:1730664616
Name:NELSON, TARA (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E 161ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3535
Mailing Address - Country:US
Mailing Address - Phone:718-579-2500
Mailing Address - Fax:718-579-2599
Practice Address - Street 1:305 E 161ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3535
Practice Address - Country:US
Practice Address - Phone:718-579-2500
Practice Address - Fax:718-579-2599
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095213104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No104100000XBehavioral Health & Social Service ProvidersSocial Worker