Provider Demographics
NPI:1316241490
Name:TAMKIN SIMONS, SHEILA DIANE (LICSW)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:DIANE
Last Name:TAMKIN SIMONS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CREST RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1442
Mailing Address - Country:US
Mailing Address - Phone:339-206-3974
Mailing Address - Fax:
Practice Address - Street 1:56 WESTOVER ST
Practice Address - Street 2:SUITE A
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1342
Practice Address - Country:US
Practice Address - Phone:339-206-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1139711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9164196OtherAETNA
MA7121168OtherCIGNA