Provider Demographics
NPI:1144287632
Name:PRERO, TAMAR A (LCSW)
Entity type:Individual
Prefix:MS
First Name:TAMAR
Middle Name:A
Last Name:PRERO
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 1:3191 VALLEY ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-4274
Mailing Address - Country:US
Mailing Address - Phone:801-403-3357
Mailing Address - Fax:801-585-2818
Practice Address - Street 1:3191 VALLEY ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-4274
Practice Address - Country:US
Practice Address - Phone:801-403-3357
Practice Address - Fax:801-585-2818
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3638013501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional