Provider Demographics
NPI:1679756894
Name:TOLSON, JEANETTE MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:MARIE
Last Name:TOLSON
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 1:27 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2710
Mailing Address - Country:US
Mailing Address - Phone:607-267-9356
Mailing Address - Fax:
Practice Address - Street 1:75 CHESTNUT ST
Practice Address - Street 2:SUITE E
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2422
Practice Address - Country:US
Practice Address - Phone:607-267-9356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72-076911104100000X
NY73 0795381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker