Provider Demographics
NPI:1639504756
Name:DUMOND, TINA M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:M
Last Name:DUMOND
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 1:171 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DEPOSIT
Mailing Address - State:NY
Mailing Address - Zip Code:13754-1316
Mailing Address - Country:US
Mailing Address - Phone:607-467-2197
Mailing Address - Fax:
Practice Address - Street 1:171 2ND ST
Practice Address - Street 2:
Practice Address - City:DEPOSIT
Practice Address - State:NY
Practice Address - Zip Code:13754-1316
Practice Address - Country:US
Practice Address - Phone:607-467-2197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086179104100000X
NY087635104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker