Provider Demographics
NPI:1508521246
Name:MILES, TINA TANGEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:TANGEN
Last Name:MILES
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 1:347 STONETOWN RD
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1217
Mailing Address - Country:US
Mailing Address - Phone:973-816-5244
Mailing Address - Fax:973-754-4650
Practice Address - Street 1:11 GETTY AVENUE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503
Practice Address - Country:US
Practice Address - Phone:973-754-2033
Practice Address - Fax:973-754-4350
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC049898001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty