Healthcare Provider Details

I. General information

NPI: 1548718299
Provider Name (Legal Business Name): TATIANA FARBER SAMLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MILL ST
BELMONT MA
02478-1064
US

IV. Provider business mailing address

115 MILL ST
BELMONT MA
02478-1064
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-2858
  • Fax:
Mailing address:
  • Phone: 617-855-2858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10490
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: