Healthcare Provider Details

I. General information

NPI: 1366178774
Provider Name (Legal Business Name): TILLMON BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ERDMAN PL APT 15F
BRONX NY
10475-5312
US

IV. Provider business mailing address

140 ERDMAN PL APT 15F
BRONX NY
10475-5312
US

V. Phone/Fax

Practice location:
  • Phone: 646-423-8795
  • Fax: 929-286-9775
Mailing address:
  • Phone: 646-423-8795
  • Fax: 929-286-9775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LINDA CHRISTINA TILLMON
Title or Position: MANAGER
Credential:
Phone: 646-423-8795