Provider Demographics
NPI:1124736756
Name:TWIN TIERS LICENSED CLINICAL SOCIAL WORK PLLC
Entity type:Organization
Organization Name:TWIN TIERS LICENSED CLINICAL SOCIAL WORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-259-1100
Mailing Address - Street 1:227 W WATER ST STE 257
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2912
Mailing Address - Country:US
Mailing Address - Phone:607-259-1100
Mailing Address - Fax:607-217-1203
Practice Address - Street 1:227 W WATER ST STE 257
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2912
Practice Address - Country:US
Practice Address - Phone:607-259-1100
Practice Address - Fax:607-217-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty