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General NPI Number Information
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NPI Number | 1396930764
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Entity Type | Individual
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Provider Name | MEGAN LARA RELIN LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 401 MAIN ST SUITE 109
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City | AMHERST
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State | MA
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Zip | 01002-2368
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Country | US
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Telephone | 413-559-1072
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Fax |
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Provider Business Mailing Address
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Address Line | 31 CAPT LATHROP DR
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City | SOUTH DEERFIELD
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State | MA
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Zip | 01373-1104
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Country | US
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Telephone | 413-559-1072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 116003
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License Number State | MA
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