Healthcare Provider Details

I. General information

NPI: 1750605283
Provider Name (Legal Business Name): TARA DURKIN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA SHOOP LCSW

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 PEACH ST
ERIE PA
16509-2482
US

IV. Provider business mailing address

5100 PEACH ST
ERIE PA
16509-2482
US

V. Phone/Fax

Practice location:
  • Phone: 814-866-4500
  • Fax: 814-864-2677
Mailing address:
  • Phone: 814-866-4500
  • Fax: 814-864-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW124363
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016626
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: