Active NPI
Tara K. Stack, MSW, LCSW-C
- Social Worker
- Bowie, MD
National Provider Identifier
1417354523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 19551
- Practice address
- 16701 Melford Blvd Ste 400
Bowie, MD 20715-4411 - Phone
- (415) 424-4266
- Fax
- (415) 520-6633
- NPI assigned
- Dec 4, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.028059 | IL | |
| Social Worker | 104100000X | 19551 | MD | Primary |
Addresses
Primary practice location
16701 Melford Blvd Ste 400
Bowie, MD 20715-4411
Mailing address
8300 Esters Blvd Ste 900
Irving, TX 75063-2233
Phone (415) 424-4266
Other practice location 1
11202 Kent Ct
New Market, MD 21774-6274
Phone (301) 606-7595
Other practice location 2
111 W Jackson Blvd Ste 1700
Chicago, IL 60604-3597
Phone (415) 424-4266
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 228022100 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19551 | MD | MD | Social Worker |
| 149.028059 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1417651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733961600000",
"number": "1417354523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8300 ESTERS BLVD STE 900",
"city": "IRVING",
"state": "TX",
"postal_code": "750632233",
"telephone_number": "415-424-4266",
"fax_number": "415-520-6633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16701 MELFORD BLVD STE 400",
"city": "BOWIE",
"state": "MD",
"postal_code": "207154411",
"telephone_number": "415-424-4266",
"fax_number": "415-520-6633"
}
],
"practiceLocations": [
{
"address_1": "11202 Kent Ct",
"address_purpose": "LOCATION",
"city": "New Market",
"state": "MD",
"postal_code": "217746274",
"country_code": "US",
"telephone_number": "301-606-7595",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "111 W Jackson Blvd Ste 1700",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606043597",
"country_code": "US",
"telephone_number": "415-424-4266",
"fax_number": "415-520-6633",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "STACK",
"first_name": "TARA",
"middle_name": "K.",
"credential": "MSW, LCSW-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-12-04",
"last_updated": "2024-12-12",
"certification_date": "2024-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.028059",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MD",
"license": "19551",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "228022100",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bowie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.