Provider Demographics
NPI:1609145200
Name:MARLIN, HOWARD B (M ED, LADC-1)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:B
Last Name:MARLIN
Suffix:
Gender:M
Credentials:M ED, LADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-5730
Mailing Address - Country:US
Mailing Address - Phone:508-687-0068
Mailing Address - Fax:
Practice Address - Street 1:45 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-5730
Practice Address - Country:US
Practice Address - Phone:508-687-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA15960101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1659687074Medicaid