Provider Demographics
NPI:1750920757
Name:NIMRY, TARA MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MICHELLE
Last Name:NIMRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 SIERRA MORENA AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-2823
Mailing Address - Country:US
Mailing Address - Phone:760-573-2161
Mailing Address - Fax:
Practice Address - Street 1:4004 SIERRA MORENA AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-2823
Practice Address - Country:US
Practice Address - Phone:760-573-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1102261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical