Provider Demographics
NPI:1245513977
Name:REDEPENNING, TARA BETH
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:BETH
Last Name:REDEPENNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 HIGHLAND AVENUE
Mailing Address - Street 2:LOOKING GLASS COUNSELING
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144
Mailing Address - Country:US
Mailing Address - Phone:617-702-9131
Mailing Address - Fax:
Practice Address - Street 1:402 HIGHLAND AVE
Practice Address - Street 2:SUITE G, LOOKING GLASS COUNSELING
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2548
Practice Address - Country:US
Practice Address - Phone:617-702-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9482101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health