Provider Demographics
NPI:1881433654
Name:FUSCO, TARA (MSW, LSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:FUSCO
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23968 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4809
Mailing Address - Country:US
Mailing Address - Phone:330-402-5771
Mailing Address - Fax:
Practice Address - Street 1:33480 LIBERTY PKWY
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2670
Practice Address - Country:US
Practice Address - Phone:440-508-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.24107401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical