Healthcare Provider Details

I. General information

NPI: 1245513977
Provider Name (Legal Business Name): TARA BETH REDEPENNING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 GREEN ST
CAMBRIDGE MA
02139-4039
US

IV. Provider business mailing address

402 HIGHLAND AVENUE LOOKING GLASS COUNSELING
SOMERVILLE MA
02144
US

V. Phone/Fax

Practice location:
  • Phone: 310-621-0010
  • Fax:
Mailing address:
  • Phone: 617-702-9131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9482
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: