Provider Demographics
NPI:1497100655
Name:MCINTYRE, TIFFANY (MSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPG
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4901
Mailing Address - Country:US
Mailing Address - Phone:205-613-0760
Mailing Address - Fax:
Practice Address - Street 1:115 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPG
Practice Address - State:FL
Practice Address - Zip Code:32701-4901
Practice Address - Country:US
Practice Address - Phone:205-613-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker