Provider Demographics
NPI:1467295030
Name:KOBASKO, TARA J (QMHS)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:J
Last Name:KOBASKO
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-2849
Mailing Address - Country:US
Mailing Address - Phone:330-385-8800
Mailing Address - Fax:
Practice Address - Street 1:165 OWINGS ST
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-2338
Practice Address - Country:US
Practice Address - Phone:304-215-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator