Provider Demographics
NPI:1255195145
Name:BISSONNETTE, TAMMY LYNN (MA, LMHC-P)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:BISSONNETTE
Suffix:
Gender:F
Credentials:MA, LMHC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 LAKE ST STE D
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4937
Mailing Address - Country:US
Mailing Address - Phone:716-410-5390
Mailing Address - Fax:716-244-9011
Practice Address - Street 1:42 LAKE ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4937
Practice Address - Country:US
Practice Address - Phone:716-410-5390
Practice Address - Fax:716-422-9011
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP118996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health