Provider Demographics
NPI:1528257631
Name:FARAJIAN, TARA BRIDGET (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:BRIDGET
Last Name:FARAJIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:BRIDGET
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4301 ATLANTIC AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2833
Mailing Address - Country:US
Mailing Address - Phone:562-650-0474
Mailing Address - Fax:562-430-4343
Practice Address - Street 1:4301 ATLANTIC AVE STE 6
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2833
Practice Address - Country:US
Practice Address - Phone:562-650-0474
Practice Address - Fax:562-430-4343
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS250821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical