Healthcare Provider Details

I. General information

NPI: 1962292466
Provider Name (Legal Business Name): TAFARA B TIMMONS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7266 BUCKLEY RD
SYRACUSE NY
13212-2649
US

IV. Provider business mailing address

406 ONONDAGA TER
SYRACUSE NY
13207-1445
US

V. Phone/Fax

Practice location:
  • Phone: 315-458-0919
  • Fax: 315-458-0954
Mailing address:
  • Phone: 315-430-6998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125757
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: