Provider Demographics
NPI:1477946259
Name:PONGRACZ, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:PONGRACZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 CHARLES DRIVE
Mailing Address - Street 2:
Mailing Address - City:DANIELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3990 CHARLES DRIVE
Practice Address - Street 2:
Practice Address - City:DANIELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18038
Practice Address - Country:US
Practice Address - Phone:484-695-1640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor