Provider Demographics
NPI:1336462506
Name:PUSHLAR, TAMIE MARIE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:TAMIE
Middle Name:MARIE
Last Name:PUSHLAR
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-9768
Mailing Address - Country:US
Mailing Address - Phone:607-342-5423
Mailing Address - Fax:
Practice Address - Street 1:230 MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13068-9768
Practice Address - Country:US
Practice Address - Phone:607-342-5423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059165104100000X
NY0774451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker