Provider Demographics
NPI:1871197665
Name:GLEBA, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:GLEBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11520 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BISCAYNE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6256
Mailing Address - Country:US
Mailing Address - Phone:201-575-1609
Mailing Address - Fax:
Practice Address - Street 1:500 NW 165TH STREET RD STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6306
Practice Address - Country:US
Practice Address - Phone:786-657-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical