Healthcare Provider Details

I. General information

NPI: 1144043597
Provider Name (Legal Business Name): MEGHAN DAHLIN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 AVENUE E APT A203
BAYONNE NJ
07002-3563
US

IV. Provider business mailing address

1187 MAIN AVE STE 3F
CLIFTON NJ
07011-2252
US

V. Phone/Fax

Practice location:
  • Phone: 315-708-7799
  • Fax:
Mailing address:
  • Phone: 855-453-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00772500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: