Provider Demographics
NPI:1720499288
Name:TARA DEVINENI, LICSW, LLC
Entity Type:Organization
Organization Name:TARA DEVINENI, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVINENI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:202-810-5786
Mailing Address - Street 1:3 WASHINGTON CIR NW
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2356
Mailing Address - Country:US
Mailing Address - Phone:202-810-5786
Mailing Address - Fax:
Practice Address - Street 1:3 WASHINGTON CIR NW
Practice Address - Street 2:SUITE 403
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2356
Practice Address - Country:US
Practice Address - Phone:202-810-5786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-17
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500793091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty