Provider Demographics
NPI:1104174937
Name:DEMULDER, TONYA ASHLEY (LCSW)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:ASHLEY
Last Name:DEMULDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 SWART HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-9077
Mailing Address - Country:US
Mailing Address - Phone:607-267-5332
Mailing Address - Fax:
Practice Address - Street 1:242 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2527
Practice Address - Country:US
Practice Address - Phone:607-433-2334
Practice Address - Fax:607-433-1364
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY0839701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical