Provider Demographics
NPI:1497302327
Name:PACHECO, TIFFANI ANNE (MSW)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:ANNE
Last Name:PACHECO
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 1:24211 DEER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-1785
Mailing Address - Country:US
Mailing Address - Phone:734-925-1896
Mailing Address - Fax:
Practice Address - Street 1:18635 BOWIE ST
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2805
Practice Address - Country:US
Practice Address - Phone:734-556-2963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program