Provider Demographics
NPI:1215095617
Name:TAMMANY, LINDA DIANE (LCSW-R)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:DIANE
Last Name:TAMMANY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 PINE PL
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1459
Mailing Address - Country:US
Mailing Address - Phone:845-399-8868
Mailing Address - Fax:
Practice Address - Street 1:1081 DEVELOPMENT CT
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1959
Practice Address - Country:US
Practice Address - Phone:845-399-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072492-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical