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Provider Information for 1831337294


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Mrs. TARA LANELL WATTS


Sex: Female

NPI: 1831337294
Last Updated: 2024-09-11
Certification Date: 2024-09-10

Details

NameValue
NPI1831337294
Enumeration Date2009-01-23
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 1345 W 7TH ST
CHESTER, PA 19013-3315
United States

Phone: 610-529-1302 | Fax:
 
Primary Practice Address 1260 E WOODLAND AVE STE 212
SPRINGFIELD, PA 19064-3956
United States

Phone: 610-566-7540 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 104100000X - Social Worker PACW016180
No 1041C0700X - Social Worker - ClinicalNJ44SC06279300
No 1041C0700X - Social Worker - ClinicalNY096247
Yes 1041C0700X - Social Worker - ClinicalPACW016180