Provider Information for 1841700036
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Ms. TARA SMITH LCSW
Other Names:Former Name:TARA SMITH MARTINEZSex: Female
NPI: 1841700036
Last Updated: 2025-02-06
Certification Date: 2025-02-06
Certification Date: 2025-02-06
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1841700036 | ||||||||||||
| Enumeration Date | 2017-10-03 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 8549 WILSHIRE BLVD UNIT 3356 BEVERLY HILLS, CA 90211-3104 United States Phone: 323-510-6975 | Fax: | ||||||||||||
| Primary Practice Address | 684 W BOUGHTON RD STE D BOLINGBROOK, IL 60440-1781 United States Phone: 773-688-4568 | Fax: | ||||||||||||
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