Provider Demographics
NPI:1932419611
Name:JONES-TARTAGLIA, TARA RENEE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:RENEE
Last Name:JONES-TARTAGLIA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:RENEE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:725 MASON ST.
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503
Mailing Address - Country:US
Mailing Address - Phone:810-257-3736
Mailing Address - Fax:810-257-3785
Practice Address - Street 1:1102 MACKIN RD.
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503
Practice Address - Country:US
Practice Address - Phone:810-257-3736
Practice Address - Fax:810-257-0713
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010780181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI386004849Medicaid