Provider Demographics
NPI:1619673506
Name:FREDERICK, TIFFANY RENEE (LMSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENEE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2316
Mailing Address - Country:US
Mailing Address - Phone:516-528-6748
Mailing Address - Fax:
Practice Address - Street 1:506 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-2316
Practice Address - Country:US
Practice Address - Phone:516-528-6748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker