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NPI Code Detail

MEDICARE: MRS. TARA ELDRIDGE LCSW

MEDICARE: MRS. TARA ELDRIDGE LCSW
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
11041C0700XClinical Social WorkerC-06429NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700091311
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TARA ELDRIDGE LCSW
Provider Business Mailing Address
First Line : 6645 VOOSCANE AVE
Second Line :
City : COCHITI LAKE
State : NM
Zip : 87083-6003
Country : US
Telephone Number : 505-474-3095
Fax Number :
Provider Business Practice Location Address
First Line : 4730 BECKNER RD
Second Line :
City : SANTA FE
State : NM
Zip : 87507-3691
Country : US
Telephone Number : 505-757-4601
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 07/29/2024

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Directions to “ MRS. TARA ELDRIDGE LCSW” Practice Location

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