Provider Demographics
NPI:1154608651
Name:QUIMBY, TARA LOUISE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:LOUISE
Last Name:QUIMBY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FIELDSTON ROAD
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:917-273-6995
Mailing Address - Fax:
Practice Address - Street 1:3600 FIELDSTON ROAD
Practice Address - Street 2:SUITE 2G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:917-273-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0781981041C0700X
NYR078198-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical