Provider Demographics
NPI:1518114586
Name:O'SHAUGHNESSY, TIFFANY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ANN
Last Name:O'SHAUGHNESSY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 DWIGHT WAY STE 7
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2365
Mailing Address - Country:US
Mailing Address - Phone:510-273-2497
Mailing Address - Fax:510-495-1120
Practice Address - Street 1:2424 DWIGHT WAY STE 7
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2365
Practice Address - Country:US
Practice Address - Phone:510-273-2497
Practice Address - Fax:510-495-1120
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NV1006103TC1900X
CA23635103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health