Provider Demographics
NPI:1205216439
Name:HAMBLETON, TIMA BULACH (LMSW)
Entity Type:Individual
Prefix:
First Name:TIMA
Middle Name:BULACH
Last Name:HAMBLETON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E 96TH ST
Mailing Address - Street 2:APT 22J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6200
Mailing Address - Country:US
Mailing Address - Phone:540-521-0307
Mailing Address - Fax:
Practice Address - Street 1:521 W 239TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1205
Practice Address - Country:US
Practice Address - Phone:540-521-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094269-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker