Provider Demographics
NPI:1881258499
Name:SMITH, TARA LYNN (LSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 OAKWOOD VLG APT 8
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-8929
Mailing Address - Country:US
Mailing Address - Phone:973-886-6562
Mailing Address - Fax:
Practice Address - Street 1:200 NORTH STREET
Practice Address - Street 2:
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608
Practice Address - Country:US
Practice Address - Phone:201-494-6570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06473600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker