Provider Demographics
NPI:1295195220
Name:TROCHE, TIFFANEY SHEVONNE (LMSW)
Entity Type:Individual
Prefix:
First Name:TIFFANEY
Middle Name:SHEVONNE
Last Name:TROCHE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 BEVERLEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3202
Mailing Address - Country:US
Mailing Address - Phone:718-437-5573
Mailing Address - Fax:718-437-5572
Practice Address - Street 1:175-14 HILLISIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5772
Practice Address - Country:US
Practice Address - Phone:718-206-9300
Practice Address - Fax:718-206-9300
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health