Provider Demographics
NPI:1437376928
Name:BATES, TANYA (BA/CASAC-T/NYSCNA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:BA/CASAC-T/NYSCNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SOUTH 27TH STREET
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11799-0000
Mailing Address - Country:US
Mailing Address - Phone:334-765-0823
Mailing Address - Fax:
Practice Address - Street 1:15 S 27TH ST
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-3705
Practice Address - Country:US
Practice Address - Phone:347-650-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YP2500X, 101YA0400X, 251V00000X
NY342004610703E171W00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171W00000XOther Service ProvidersContractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY342004610703EOtherNYS-CNA, HHA