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General NPI Number Information
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NPI Number | 1457891707
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Entity Type | Organization
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Legal Business Name | TARA INCOPERO PC
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 381 N YORK ST SUITE 18
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City | ELMHURST
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State | IL
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Zip | 60126-2342
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Country | US
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Telephone | 630-796-4367
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Fax |
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Provider Business Mailing Address
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Address Line | 381 N YORK ST SUITE 18
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City | ELMHURST
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State | IL
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Zip | 60126-2342
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Country | US
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Telephone | 630-796-4367
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TARA INCOPERO
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Credential | LCSW
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Telephone | 630-849-7042
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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 | 149.018682
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License Number State | IL
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