Provider Demographics
NPI:1396930764
Name:RELIN, MEGAN LARA (LICSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LARA
Last Name:RELIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CAPT LATHROP DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-1104
Mailing Address - Country:US
Mailing Address - Phone:413-559-1072
Mailing Address - Fax:
Practice Address - Street 1:401 MAIN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2368
Practice Address - Country:US
Practice Address - Phone:413-559-1072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1160031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical