Healthcare Provider Details

I. General information

NPI: 1629933874
Provider Name (Legal Business Name): TARA ANNE GILLIARD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4542 OCEANIA ST FL 2
BAYSIDE NY
11361-3254
US

IV. Provider business mailing address

4542 OCEANIA ST FL 2
BAYSIDE NY
11361-3254
US

V. Phone/Fax

Practice location:
  • Phone: 917-940-9155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123196
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: