Provider Demographics
NPI:1821675737
Name:BAYSOL, TARA JULIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:JULIA
Last Name:BAYSOL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:JULIA
Other - Last Name:BURGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 HUNNEWELL RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9539
Mailing Address - Country:US
Mailing Address - Phone:207-835-1334
Mailing Address - Fax:
Practice Address - Street 1:9 HUNNEWELL RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9539
Practice Address - Country:US
Practice Address - Phone:207-835-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC195701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical