Provider Demographics
NPI:1578852844
Name:WALTERS, TARA CELESTE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:CELESTE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HOFFMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690
Mailing Address - Country:US
Mailing Address - Phone:609-273-5702
Mailing Address - Fax:609-838-1756
Practice Address - Street 1:100 HORIZON CENTER BLVD FL 1
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08691-1910
Practice Address - Country:US
Practice Address - Phone:609-222-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047586001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical