Provider Demographics
NPI:1023576857
Name:JONES, TIARA SHANDELE
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:SHANDELE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 GARRETT RD APT 301
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-4472
Mailing Address - Country:US
Mailing Address - Phone:215-370-0016
Mailing Address - Fax:
Practice Address - Street 1:1600 GARRETT RD APT 301
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-4472
Practice Address - Country:US
Practice Address - Phone:215-370-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135656104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty