Provider Demographics
NPI:1922713627
Name:GRIFFITH, TARA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:GRIFFITH
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 1:3832-10 BAYMEADOWS RD # 134
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-5606
Mailing Address - Country:US
Mailing Address - Phone:850-590-7098
Mailing Address - Fax:904-299-9985
Practice Address - Street 1:10163 FORTUNE PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3519
Practice Address - Country:US
Practice Address - Phone:850-590-7098
Practice Address - Fax:904-299-9985
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW188851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical