Healthcare Provider Details

I. General information

NPI: 1760145593
Provider Name (Legal Business Name): TARA ANDERMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24938 HARPER AVE
SAINT CLAIR SHORES MI
48080-1242
US

IV. Provider business mailing address

24938 HARPER AVE
SAINT CLAIR SHORES MI
48080-1242
US

V. Phone/Fax

Practice location:
  • Phone: 586-242-0027
  • Fax:
Mailing address:
  • Phone: 586-242-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801122330
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: