Provider Demographics
NPI:1952844102
Name:WALSH, TARA (LPC, LCADC, ACS)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:LPC, LCADC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 GODWIN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1463
Mailing Address - Country:US
Mailing Address - Phone:201-444-8110
Mailing Address - Fax:
Practice Address - Street 1:666 GODWIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1463
Practice Address - Country:US
Practice Address - Phone:201-444-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00342000101YM0800X
NJ37PC00684600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health