Healthcare Provider Details

I. General information

NPI: 1376893149
Provider Name (Legal Business Name): TANYA WASHINGTON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 JEANNE DR
NEWBURGH NY
12550
US

IV. Provider business mailing address

20 LONG VIEW DR. P.O. BOX 572
UNIONVILLE NY
10988
US

V. Phone/Fax

Practice location:
  • Phone: 845-741-6168
  • Fax:
Mailing address:
  • Phone: 845-741-6168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number079368
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: