Provider Demographics
NPI:1700403474
Name:BEANE, TIFFANY ANN (RBT)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ANN
Last Name:BEANE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MRS
Other - First Name:TIFFANY
Other - Middle Name:ANN
Other - Last Name:LOWTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 FRONT ST # 8
Mailing Address - Street 2:
Mailing Address - City:KEESEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12944-3619
Mailing Address - Country:US
Mailing Address - Phone:518-834-7071
Mailing Address - Fax:
Practice Address - Street 1:1701 FRONT ST # 8
Practice Address - Street 2:
Practice Address - City:KEESEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12944-3619
Practice Address - Country:US
Practice Address - Phone:518-834-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician