MEDICARE: DR. TANYA ESTELLA WILLIAMSON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	015743	NY

General Provider Information

NPI Number	:	1720134489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANYA ESTELLA WILLIAMSON PH.D.

Provider Business Mailing Address
First Line	:	6858 E GENESEE ST
Second Line	:	2ND FLOOR
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1051
Country	:	US
Telephone Number	:	315-703-3033
Fax Number	:	315-703-3033

Provider Business Practice Location Address
First Line	:	6858 E GENESEE ST
Second Line	:	2ND FLOOR
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1051
Country	:	US
Telephone Number	:	315-703-3033
Fax Number	:	315-703-3033

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	05/21/2009

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