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General NPI Number Information
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NPI Number | 1417335365
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Entity Type | Organization
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Legal Business Name | TAMAR PORT COUNSELING LLC
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 826 VILLAGE CIR
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City | BLUE BELL
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State | PA
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Zip | 19422-1639
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Country | US
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Telephone | 215-530-2564
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Fax |
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Provider Business Mailing Address
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Address Line | 826 VILLAGE CIR
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City | BLUE BELL
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State | PA
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Zip | 19422-1639
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Country | US
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Telephone | 215-530-2564
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Fax | 215-646-5253
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MRS. TAMAR JUDITH PORT
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Credential | M.S.S
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Telephone | 215-530-2564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW000153L
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License Number State | PA
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