Provider Demographics
NPI:1558107573
Name:GERDON-DRAPPO, TARA (LMSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:GERDON-DRAPPO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:DRAPPO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:6610 E UNIVERSITY DR UNIT 179
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-7653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6610 E UNIVERSITY DR UNIT 179
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-7653
Practice Address - Country:US
Practice Address - Phone:858-634-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-08122T1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty