Provider Demographics
NPI:1700473964
Name:TAVERAS, PATRICIA (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:TAVERAS
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18C ASHINGTON CLUB RD
Mailing Address - Street 2:
Mailing Address - City:FAR HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07931-2497
Mailing Address - Country:US
Mailing Address - Phone:732-762-2919
Mailing Address - Fax:
Practice Address - Street 1:18C ASHINGTON CLUB RD
Practice Address - Street 2:
Practice Address - City:FAR HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07931-2497
Practice Address - Country:US
Practice Address - Phone:732-762-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057120001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical