Provider Demographics
NPI:1295987832
Name:TATUM, MEGHAN VORIS (LCSW)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:VORIS
Last Name:TATUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:GRODEN
Other - Last Name:VORIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:120 E 56TH ST
Mailing Address - Street 2:SUITE 540
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3607
Mailing Address - Country:US
Mailing Address - Phone:347-921-0342
Mailing Address - Fax:
Practice Address - Street 1:120 E 56TH ST
Practice Address - Street 2:SUITE 540
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3607
Practice Address - Country:US
Practice Address - Phone:347-921-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040065881041C0700X
DCLC500788471041C0700X
NY080201-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical