Provider Demographics
NPI:1336277011
Name:TANKLOW, KAREN S (MSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:S
Last Name:TANKLOW
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:WAC037
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-643-7184
Mailing Address - Fax:617-726-0822
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:WAC037
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-643-7184
Practice Address - Fax:617-726-0822
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1052141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical