Provider Demographics
NPI:1689294597
Name:IRIZARRY, TIFFANY JACQUELINE (LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JACQUELINE
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:JACQUELINE
Other - Last Name:MANDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:12 LEICESTER LN
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2228
Mailing Address - Country:US
Mailing Address - Phone:609-462-9272
Mailing Address - Fax:
Practice Address - Street 1:3836 QUAKERBRIDGE RD STE 108
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1006
Practice Address - Country:US
Practice Address - Phone:856-354-0664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00697900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional