Provider Demographics
NPI:1518500743
Name:TIMOTHEE, TANISHA (LCSW)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:TIMOTHEE
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 1:75 LAKE RD STE 318
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-2342
Mailing Address - Country:US
Mailing Address - Phone:914-372-6731
Mailing Address - Fax:
Practice Address - Street 1:75 LAKE RD STE 318
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-2342
Practice Address - Country:US
Practice Address - Phone:914-372-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0944891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical