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General NPI Number Information
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NPI Number | 1609315316
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Entity Type | Individual
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Provider Name | TARA IGNONT LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 3301 E 12TH ST STE 259
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City | OAKLAND
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State | CA
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Zip | 94601-2940
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Country | US
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Telephone | 510-807-2450
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Fax |
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Provider Business Mailing Address
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Address Line | 3480 BUSKIRK AVE SUITE 210
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City | PLEASANT HILL
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State | CA
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Zip | 94523-4341
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Country | US
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Telephone | 925-933-2627
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 73828
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 88309
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 88309
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License Number State | CA
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