Provider Demographics
NPI:1598913816
Name:TOMPKINS, JOANNA MARIE-KELTOS (LCSW)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARIE-KELTOS
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:MARIE
Other - Last Name:KELTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:116 CLAYTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2430
Mailing Address - Country:US
Mailing Address - Phone:607-754-1101
Mailing Address - Fax:
Practice Address - Street 1:116 CLAYTON AVE STE A
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2430
Practice Address - Country:US
Practice Address - Phone:607-754-1101
Practice Address - Fax:607-754-1107
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0805211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical