MEDICARE: TARA LYNN DANIELS

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	022036	PA

General Provider Information

NPI Number	:	1700545373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA LYNN DANIELS

Provider Business Mailing Address
First Line	:	1377 GREENHILL RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17403-3032
Country	:	US
Telephone Number	:	717-360-8908
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 CONCORD RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-8741
Country	:	US
Telephone Number	:	717-885-0503
Fax Number	:

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

Provider Enumeration Date	:	12/10/2021
Last Update Date	:	12/10/2021

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