Provider Demographics
NPI:1033104302
Name:ANGLIN, TAMARIN L (LSCSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:TAMARIN
Middle Name:L
Last Name:ANGLIN
Suffix:
Gender:F
Credentials:LSCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 W JEFFERSON BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6894
Mailing Address - Country:US
Mailing Address - Phone:260-486-5251
Mailing Address - Fax:260-486-5058
Practice Address - Street 1:4109 W JEFFERSON BLVD
Practice Address - Street 2:STE A
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6894
Practice Address - Country:US
Practice Address - Phone:260-486-5251
Practice Address - Fax:260-486-5058
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000847A104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
170924000OtherMAGELLAN BEHAVIORAL HEALT
3516695480008OtherCIGNA
0007289125OtherAETNA
071833OtherVALUE OPTIONS
0007289125OtherAETNA US HEALTHCARE
000000143174OtherANTHEM