Provider Demographics
NPI:1447495205
Name:MCHUGH, TARA JUSTINE (LMSW)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:JUSTINE
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:JUSTINE
Other - Last Name:GILSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 COLIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAST YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11967
Mailing Address - Country:US
Mailing Address - Phone:631-205-2820
Mailing Address - Fax:631-205-5826
Practice Address - Street 1:141 COLIN DRIVE
Practice Address - Street 2:
Practice Address - City:EAST YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11967
Practice Address - Country:US
Practice Address - Phone:631-205-2820
Practice Address - Fax:631-205-5826
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042313DVP1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical