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Individual
PENNY TAVAR
Active
Individual
PENNY TAVAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
3415
CT
1041C0700X
Clinical Social Worker
Primary
10869
CT
Other
Enumeration date
03/28/2017
Last updated
03/04/2020
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