Provider Demographics
NPI:1689320426
Name:CUPIT, TARA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:CUPIT
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 1:220 W CHELTEN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3803
Mailing Address - Country:US
Mailing Address - Phone:215-310-7022
Mailing Address - Fax:267-281-1744
Practice Address - Street 1:220 W CHELTEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3803
Practice Address - Country:US
Practice Address - Phone:215-310-7022
Practice Address - Fax:267-281-1744
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0209801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical