Provider Demographics
NPI:1902983893
Name:TINKER, JAMES EDWIN (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWIN
Last Name:TINKER
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N MAIN ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2901
Mailing Address - Country:US
Mailing Address - Phone:607-731-5474
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2901
Practice Address - Country:US
Practice Address - Phone:607-731-5474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0762171041C0700X
NY0685491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00068549Medicaid