Provider Demographics
NPI:1023558012
Name:NORTON, TIFFANY (MHRT-C)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:NORTON
Suffix:
Gender:F
Credentials:MHRT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 N CLARY RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:ME
Mailing Address - Zip Code:04348-4067
Mailing Address - Country:US
Mailing Address - Phone:207-557-3194
Mailing Address - Fax:207-549-0150
Practice Address - Street 1:518 N CLARY RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:ME
Practice Address - Zip Code:04348-4067
Practice Address - Country:US
Practice Address - Phone:207-557-3194
Practice Address - Fax:207-549-0150
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities