Provider Demographics
NPI:1629667431
Name:KROLL GARCIA, TIFFANY N (LCSW, SAC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:N
Last Name:KROLL GARCIA
Suffix:
Gender:F
Credentials:LCSW, SAC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:903 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2970
Mailing Address - Country:US
Mailing Address - Phone:608-756-5555
Mailing Address - Fax:608-756-0174
Practice Address - Street 1:903 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2970
Practice Address - Country:US
Practice Address - Phone:608-756-5555
Practice Address - Fax:608-756-0174
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16514-131101YA0400X
WI131004104100000X
WI9821-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1629667431Medicaid