MEDICARE: MRS. TARA STEGALL HOMEIER 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
1	1041C0700X	Clinical Social Worker	SW10032	FL

General Provider Information

NPI Number	:	1700187358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA STEGALL HOMEIER LCSW

Provider Business Mailing Address
First Line	:	360 LANIER DR
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-1923
Country	:	US
Telephone Number	:	561-969-6415
Fax Number	:

Provider Business Practice Location Address
First Line	:	2341 S MILITARY TRL
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-7543
Country	:	US
Telephone Number	:	561-202-4277
Fax Number	:

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

Provider Enumeration Date	:	11/14/2010
Last Update Date	:	11/14/2010

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