Provider Demographics
NPI:1720134489
Name:WILLIAMSON, TANYA ESTELLA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:ESTELLA
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6858 E GENESEE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1051
Mailing Address - Country:US
Mailing Address - Phone:315-703-3033
Mailing Address - Fax:315-703-3033
Practice Address - Street 1:6858 E GENESEE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1051
Practice Address - Country:US
Practice Address - Phone:315-703-3033
Practice Address - Fax:315-703-3033
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015743103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical