Provider Demographics
NPI:1346895091
Name:LUMPKIN, TANISHA (CPS)
Entity Type:Individual
Prefix:MS
First Name:TANISHA
Middle Name:
Last Name:LUMPKIN
Suffix:
Gender:F
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FLATBUSH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2499
Mailing Address - Country:US
Mailing Address - Phone:718-852-2584
Mailing Address - Fax:
Practice Address - Street 1:25 ELM PL FL 6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5826
Practice Address - Country:US
Practice Address - Phone:718-852-5212
Practice Address - Fax:718-285-8610
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-P-3121175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist