Healthcare Provider Details

I. General information

NPI: 1851635296
Provider Name (Legal Business Name): ERICA TAMLYN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 JACKSON ST
LOWELL MA
01852-2103
US

IV. Provider business mailing address

161 JACKSON ST
LOWELL MA
01852-2103
US

V. Phone/Fax

Practice location:
  • Phone: 978-746-7867
  • Fax:
Mailing address:
  • Phone: 978-746-7861
  • Fax: 978-275-9890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119629
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: