MEDICARE: MS. TARA-MARIE LINNE LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC301887	DC

General Provider Information

NPI Number	:	1659377430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TARA-MARIE LINNE LICSW

Provider Business Mailing Address
First Line	:	829 MORGAN GROVE RD
Second Line	:
City	:	SHEPHERDSTOWN
State	:	WV
Zip	:	25443-4540
Country	:	US
Telephone Number	:	304-876-0941
Fax Number	:	304-876-0941

Provider Business Practice Location Address
First Line	:	829 MORGAN GROVE RD
Second Line	:
City	:	SHEPHERDSTOWN
State	:	WV
Zip	:	25443-4540
Country	:	US
Telephone Number	:	304-876-0941
Fax Number	:	304-876-0941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2005
Last Update Date	:	07/08/2007

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