=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376893149
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANYA WASHINGTON LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2012
-----------------------------------------------------
Last Update Date | 09/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 JEANNE DR
-----------------------------------------------------
City | NEWBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-741-6168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 LONG VIEW DR. P.O. BOX 572
-----------------------------------------------------
City | UNIONVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-741-6168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 079368
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------