Provider Demographics
NPI:1275024895
Name:SIMMONS, TIFFANY L
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:L
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TIFFANY
Other - Middle Name:L
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1851
Mailing Address - Country:US
Mailing Address - Phone:207-542-4616
Mailing Address - Fax:
Practice Address - Street 1:211 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-1851
Practice Address - Country:US
Practice Address - Phone:207-542-4616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician