{"npi":"1861719643","type":"NPI-1","status":"active","name":{"display":"Tara Ellis LCSW","other":[{"code":"1","type":"Formerly known as","value":"SMOLLEN, TARA"}],"first":"TARA","last":"ELLIS","credential":"LCSW"},"specialty":{"primary_taxonomy":"1041C0700X","primary_taxonomy_description":"Clinical Social Worker","slug":"clinical-social-worker","schema_org_specialty":null,"all":[{"code":"1041C0700X","description":"Clinical Social Worker","primary":true,"state":"CT","license":"007912"}]},"addresses":[{"purpose":"LOCATION","street_1":"675 MAIN ST","city":"MIDDLETOWN","state":"CT","postal_code":"064572718","country_code":"US","phone":"8903476971","fax":"8603437379"},{"purpose":"MAILING","street_1":"575 MAIN ST 2ND FLOOR","city":"MIDDLETOWN","state":"CT","postal_code":"064572718","country_code":"US","street_2":"ATTN: CREDENTIALING DPT","phone":"8903476971","fax":"8606386601"}],"license":{"state":"CT","number":"007912"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"008023083","state":"CT","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20100623000134","type_code":"14-80","type_desc":"PRACTITIONER - CLINICAL SOCIAL WORKER","state":"CT","pac_id":"1355472168"}]},"enumeration_date":"2010-05-03","last_updated":"2015-03-16","_meta":{"source":"NPPES","snapshot_date":"2015-03-16","doc_url":"https://findmynpi.com/api"}}