Provider Demographics
NPI:1104014182
Name:TEAMER, TIFFANY DEMICHELE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:DEMICHELE
Last Name:TEAMER
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 1:17 CLARK HTS
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7757
Mailing Address - Country:US
Mailing Address - Phone:845-838-4920
Mailing Address - Fax:845-838-4924
Practice Address - Street 1:223 MAIN ST
Practice Address - Street 2:ASTOR SERVICES FOR CHILDREN & FAMILIES
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508
Practice Address - Country:US
Practice Address - Phone:845-838-4920
Practice Address - Fax:845-838-4924
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0796901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical