Provider Demographics
NPI:1386871150
Name:TROISE, TARA J (LCSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:J
Last Name:TROISE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:J
Other - Last Name:KIMBRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:461 N HILLSBORO RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-4431
Mailing Address - Country:US
Mailing Address - Phone:518-763-9267
Mailing Address - Fax:
Practice Address - Street 1:461 N HILLSBORO RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-4431
Practice Address - Country:US
Practice Address - Phone:518-763-9267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00007451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical