| Kelly Tarascio Lcsw | |
|
72 N Elm St Apt 2b Canaan CT 06018-2162 | |
| (203) 558-0056 | |
| Not Available |
| Full Name | Kelly Tarascio Lcsw |
|---|---|
| Speciality | Social Worker |
| Location | 72 N Elm St Apt 2b, Canaan, Connecticut |
| Authorized Official Name and Position | Kelly Tarascio (OWNER) |
| Authorized Official Contact | 2035580056 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Tarascio Lcsw 72 N Elm St Apt 2b Canaan CT 06018-2162 Ph: (203) 558-0056 | Kelly Tarascio Lcsw 72 N Elm St Apt 2b Canaan CT 06018-2162 Ph: (203) 558-0056 |
| NPI Number | 1114749827 |
|---|---|
| Provider Enumeration Date | 10/25/2024 |
| Last Update Date | 01/02/2025 |
| Certification Date | 01/02/2025 |
| Medicare PECOS PAC ID | 4486181633 |
|---|---|
| Medicare Enrollment ID | O20241230001114 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114749827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kelly Tarascio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174112262 PECOS PAC ID: 9234500554 Enrollment ID: I20230125000858 |
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