Provider Demographics
NPI:1316005796
Name:POPOLOSKI, TANYA MARIE (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:MARIE
Last Name:POPOLOSKI
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 BELMONT ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-5138
Mailing Address - Country:US
Mailing Address - Phone:603-651-7242
Mailing Address - Fax:
Practice Address - Street 1:121 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1981
Practice Address - Country:US
Practice Address - Phone:603-651-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical