Provider Demographics
NPI:1891959375
Name:CONSOLINO, TARA (DSW, MSW, LMSW)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:CONSOLINO
Suffix:
Gender:F
Credentials:DSW, MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38215 LANA DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2748
Mailing Address - Country:US
Mailing Address - Phone:347-564-8876
Mailing Address - Fax:
Practice Address - Street 1:38215 LANA DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2748
Practice Address - Country:US
Practice Address - Phone:347-564-8876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2024-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010856701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1891959375OtherNPI 1
MI1124701404OtherNPI 2