Provider Demographics
NPI:1063797728
Name:TIMMONS, IDA BELINDA (LMSW)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:BELINDA
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 KREAMER ST
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2343
Mailing Address - Country:US
Mailing Address - Phone:631-730-1665
Mailing Address - Fax:
Practice Address - Street 1:37 KREAMER ST
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2343
Practice Address - Country:US
Practice Address - Phone:631-730-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0734171041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool