Provider Demographics
NPI:1669631487
Name:BOURQUIN, TIFFANY (LMHC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:BOURQUIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 577
Mailing Address - Street 2:UNITED STATES
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-2840
Mailing Address - Country:US
Mailing Address - Phone:401-924-3924
Mailing Address - Fax:401-619-7766
Practice Address - Street 1:575 E MAIN RD UNIT 4
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842
Practice Address - Country:US
Practice Address - Phone:401-924-3924
Practice Address - Fax:401-619-7766
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health