Healthcare Provider Details

I. General information

NPI: 1710638507
Provider Name (Legal Business Name): TIMOTHY SESSOMS M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2894 VALENTINE AVE
BRONX NY
10458-2702
US

IV. Provider business mailing address

1032 REV JAMES A POLITE AVE # 3B
BRONX NY
10459-2701
US

V. Phone/Fax

Practice location:
  • Phone: 914-373-9722
  • Fax:
Mailing address:
  • Phone: 914-373-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: