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General NPI Number Information
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NPI Number | 1740613769
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Entity Type | Individual
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Provider Name | TARA LYNN PINNACOLI LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 8142 SE FEDERAL HWY
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City | HOBE SOUND
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State | FL
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Zip | 33455-6085
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Country | US
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Telephone | 772-215-6156
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Fax |
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Provider Business Mailing Address
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Address Line | 630 NE ZEBRINA SENDA
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City | JENSEN BEACH
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State | FL
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Zip | 34957-6665
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Country | US
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Telephone | 772-215-6156
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Fax | 772-210-1272
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SW129563
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SW12666
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License Number State | FL
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