Provider Demographics
NPI:1659629913
Name:PANDARINATH, TARA MCSHANE (MSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MCSHANE
Last Name:PANDARINATH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LEIGH
Other - Last Name:MCSHANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 FELL ST APT 105
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5134
Mailing Address - Country:US
Mailing Address - Phone:415-891-7908
Mailing Address - Fax:
Practice Address - Street 1:1340 TULLY RD STE 304
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3055
Practice Address - Country:US
Practice Address - Phone:408-271-3900
Practice Address - Fax:408-271-3909
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33608104100000X
NY082650-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker