Provider Demographics
NPI:1013017250
Name:FOLGER, TINA ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:ANNE
Last Name:FOLGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WINDING LN
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-5426
Mailing Address - Country:US
Mailing Address - Phone:607-773-0034
Mailing Address - Fax:607-770-1916
Practice Address - Street 1:217 RAIFORD RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3252
Practice Address - Country:US
Practice Address - Phone:607-773-0034
Practice Address - Fax:607-770-1916
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038460-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical