Provider Demographics
NPI:1598406555
Name:ABSELEM, DANA SHAW TARNOFF (LCSW)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:SHAW TARNOFF
Last Name:ABSELEM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:SHAW
Other - Last Name:TARNOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:234 COPELAND ST STE 320
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:234 COPELAND ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4081
Practice Address - Country:US
Practice Address - Phone:617-479-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2253151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical