Provider Demographics
NPI:1528737418
Name:EGAN-HARRIS, TARA HELEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:HELEN
Last Name:EGAN-HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:HELEN
Other - Last Name:EGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:429 W GRANT PL APT C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7524
Mailing Address - Country:US
Mailing Address - Phone:773-318-3270
Mailing Address - Fax:
Practice Address - Street 1:429 W GRANT PL APT C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7524
Practice Address - Country:US
Practice Address - Phone:773-318-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0164921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical