Basic Information
| Provider Information | |||||||||
| NPI: | 1841815115 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TARA BROPHY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 JACKSON AVE | ||||||||
| Address2: | |||||||||
| City: | MAGNOLIA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080491220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562209375 | ||||||||
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| Practice Location | |||||||||
| Address1: | 215 HIGHLAND AVE STE C | ||||||||
| Address2: | |||||||||
| City: | HADDON TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081082634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562209375 | ||||||||
| FaxNumber: | 8568540992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2020 | ||||||||
| LastUpdateDate: | 06/12/2020 | ||||||||
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| AuthorizedOfficialLastName: | BROPHY | ||||||||
| AuthorizedOfficialFirstName: | TARA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8562209375 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 06/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.