Provider Demographics
NPI:1588393680
Name:KIELICH, TARA (LMSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:KIELICH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 ALBERTA DR STE 2
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1139
Mailing Address - Country:US
Mailing Address - Phone:716-832-0720
Mailing Address - Fax:
Practice Address - Street 1:575 ALBERTA DR STE 2
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1139
Practice Address - Country:US
Practice Address - Phone:716-832-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor