Provider Demographics
NPI:1437583580
Name:RODGERS, TIFFANY CHIANTI (LCSW, BCABA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CHIANTI
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LCSW, BCABA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:CHIANTI
Other - Last Name:BANNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, BCABA
Mailing Address - Street 1:5967 RIDGE LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-5093
Mailing Address - Country:US
Mailing Address - Phone:772-480-3490
Mailing Address - Fax:
Practice Address - Street 1:5967 RIDGE LAKE CIR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-5093
Practice Address - Country:US
Practice Address - Phone:772-480-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB372034103K00000X
106E00000X
FLISW73221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst