Provider Demographics
NPI:1932953684
Name:DEFELICE, TARA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:DEFELICE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:KNISELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2131
Mailing Address - Country:US
Mailing Address - Phone:412-436-0405
Mailing Address - Fax:
Practice Address - Street 1:301 MEADE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-2131
Practice Address - Country:US
Practice Address - Phone:412-436-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW141378104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker