MEDICARE: TARA HUGHES LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	19643	MD

General Provider Information

NPI Number	:	1033593900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA HUGHES LCSW-C

Provider Business Mailing Address
First Line	:	3820 GREEN ASH CT
Second Line	:
City	:	RANDALLSTOWN
State	:	MD
Zip	:	21133-2808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9201 PHILADELPHIA RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21237-4318
Country	:	US
Telephone Number	:	410-574-7700
Fax Number	:	410-574-1522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2015
Last Update Date	:	07/10/2015

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