Provider Demographics
NPI:1871008706
Name:TARA DEVINENI LCSW LLC
Entity Type:Organization
Organization Name:TARA DEVINENI LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVINENI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:484-424-7218
Mailing Address - Street 1:1137 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1243
Mailing Address - Country:US
Mailing Address - Phone:484-424-7218
Mailing Address - Fax:
Practice Address - Street 1:1137 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1243
Practice Address - Country:US
Practice Address - Phone:484-424-7218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW019653261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health