| Tara Brophy LLC | |
|
215 Highland Ave Ste C Haddon Township NJ 08108-2634 | |
| (856) 220-9375 | |
| (856) 854-0992 |
| Full Name | Tara Brophy LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 215 Highland Ave Ste C, Haddon Township, New Jersey |
| Authorized Official Name and Position | Tara L Brophy (OWNER) |
| Authorized Official Contact | 8562209375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tara Brophy LLC 202 Jackson Ave Magnolia NJ 08049-1220 Ph: (856) 220-9375 | Tara Brophy LLC 215 Highland Ave Ste C Haddon Township NJ 08108-2634 Ph: (856) 220-9375 |
| NPI Number | 1841815115 |
|---|---|
| Provider Enumeration Date | 06/12/2020 |
| Last Update Date | 06/12/2020 |
| Certification Date | 06/12/2020 |
| Medicare PECOS PAC ID | 4981026283 |
|---|---|
| Medicare Enrollment ID | O20200615001299 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841815115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (NU) | Primary |
| Provider Name | Tara L Brophy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316284128 PECOS PAC ID: 7214359512 Enrollment ID: I20200615001627 |
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