Provider Demographics
NPI:1699590190
Name:ROY-PABLO, TARA (LMSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ROY-PABLO
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 1:4568 E THISTLE LANDING DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6849
Mailing Address - Country:US
Mailing Address - Phone:480-205-0158
Mailing Address - Fax:
Practice Address - Street 1:1515 E FLORENCE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5334
Practice Address - Country:US
Practice Address - Phone:602-935-6299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-12243104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker