Healthcare Provider Details

I. General information

NPI: 1982225645
Provider Name (Legal Business Name): TARA JUDITH PALMA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA JUDITH PALMA LSW

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SPRINGDALE RD STE 150
CHERRY HILL NJ
08003-2728
US

IV. Provider business mailing address

705 QUAIL RD
MARLTON NJ
08053-5007
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-1333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: