Provider Demographics
NPI:1982499919
Name:WHITELEY, TARA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:WHITELEY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4008
Mailing Address - Country:US
Mailing Address - Phone:203-470-6444
Mailing Address - Fax:
Practice Address - Street 1:71 ELM ST STE 3
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5429
Practice Address - Country:US
Practice Address - Phone:203-470-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0142921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical