Provider Demographics
NPI:1457577215
Name:TOLAND, TARA SR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:TOLAND
Suffix:SR
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:TOLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4138 N RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2614
Mailing Address - Country:US
Mailing Address - Phone:773-583-7604
Mailing Address - Fax:
Practice Address - Street 1:4138 N RICHMOND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-2614
Practice Address - Country:US
Practice Address - Phone:773-583-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0054741041C0700X
ILTT20360603P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist