Provider Demographics
NPI:1306269717
Name:KING, TINA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:KING
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 1:75 JONES AND GIFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2828
Mailing Address - Country:US
Mailing Address - Phone:716-661-4728
Mailing Address - Fax:716-661-1074
Practice Address - Street 1:75 JONES AND GIFFORD AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2828
Practice Address - Country:US
Practice Address - Phone:716-661-4728
Practice Address - Fax:716-661-1074
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088179104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker