Provider Demographics
NPI:1972769156
Name:HENGSTENBERG, TARA LEIGH (LSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LEIGH
Last Name:HENGSTENBERG
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2728
Mailing Address - Country:US
Mailing Address - Phone:732-549-6000
Mailing Address - Fax:732-767-9767
Practice Address - Street 1:224 MAIN ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2728
Practice Address - Country:US
Practice Address - Phone:732-549-6000
Practice Address - Fax:732-767-9767
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05503900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker