Provider Demographics
NPI:1477260438
Name:WELLINGTON-SIMPSON, TIFFANY NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:NICOLE
Last Name:WELLINGTON-SIMPSON
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 1:10 LEHIGH AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2808
Mailing Address - Country:US
Mailing Address - Phone:862-220-5334
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:228 LAFAYETTE ST FL 4
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1815
Practice Address - Country:US
Practice Address - Phone:973-789-8111
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059382001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty