Provider Demographics
NPI:1588063119
Name:PIERCE, TARA MARILYN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:MARILYN
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:95 ALLENS CREEK RD
Mailing Address - Street 2:EXECUTIVE SQUARE, BLDG 2, SUITE 326
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3250
Mailing Address - Country:US
Mailing Address - Phone:315-521-1093
Mailing Address - Fax:
Practice Address - Street 1:95 ALLENS CREEK RD
Practice Address - Street 2:EXECUTIVE SQUARE, BLDG 2, SUITE 326
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3250
Practice Address - Country:US
Practice Address - Phone:315-521-1093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083509-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical