Provider Demographics
NPI:1316647902
Name:LAMARCA, TARA KENWORTHY (PHD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:KENWORTHY
Last Name:LAMARCA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LYNNE
Other - Last Name:KENWORTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2820 NE 55TH PL
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3456
Mailing Address - Country:US
Mailing Address - Phone:617-710-7101
Mailing Address - Fax:
Practice Address - Street 1:1601 NW 12TH AVE RM 2047
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-243-6857
Practice Address - Fax:305-243-4512
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11746103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist