Provider Demographics
NPI:1164649570
Name:MUGLIA, TARA ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ANN
Last Name:MUGLIA
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 1:426 N RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4145
Mailing Address - Country:US
Mailing Address - Phone:718-370-2084
Mailing Address - Fax:
Practice Address - Street 1:1492 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2319
Practice Address - Country:US
Practice Address - Phone:917-770-9757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071069-11041C0700X
NY077025-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical