Provider Demographics
NPI:1124130091
Name:TARLIN, DANIEL GORDON (LICSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:GORDON
Last Name:TARLIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CANNON BALL RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2857
Mailing Address - Country:US
Mailing Address - Phone:508-930-7921
Mailing Address - Fax:508-543-3692
Practice Address - Street 1:40 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2074
Practice Address - Country:US
Practice Address - Phone:508-930-7921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10273681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22953Medicare ID - Type Unspecified