Healthcare Provider Details

I. General information

NPI: 1609145200
Provider Name (Legal Business Name): HOWARD B MARLIN M. ED, LADC-1
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CENTRAL AVE
VINEYARD HAVEN MA
02568-5730
US

IV. Provider business mailing address

45 CENTRAL AVE
VINEYARD HAVEN MA
02568-5730
US

V. Phone/Fax

Practice location:
  • Phone: 508-687-0068
  • Fax:
Mailing address:
  • Phone: 508-687-0068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15960
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1659687074
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: