Provider Demographics
NPI:1235247065
Name:TAMBLYN, SHON LAWRENCE (MSW)
Entity Type:Individual
Prefix:MR
First Name:SHON
Middle Name:LAWRENCE
Last Name:TAMBLYN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 AUBURN BLVD STE 1200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4153
Mailing Address - Country:US
Mailing Address - Phone:916-418-0828
Mailing Address - Fax:916-418-0838
Practice Address - Street 1:4320 AUBURN BLVD STE 1200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4153
Practice Address - Country:US
Practice Address - Phone:916-418-0828
Practice Address - Fax:916-418-0838
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW175571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical