Provider Demographics
NPI:1518253673
Name:TOWNSEND, TIFFANY BRYANT
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:BRYANT
Last Name:TOWNSEND
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 1:6 CROCKER ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2846
Mailing Address - Country:US
Mailing Address - Phone:774-766-8335
Mailing Address - Fax:
Practice Address - Street 1:100 ARMSTRONG RD STE 101A
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7224
Practice Address - Country:US
Practice Address - Phone:774-766-8335
Practice Address - Fax:508-475-5468
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA9461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health