Provider Demographics
NPI:1710091897
Name:GREER, TIFFANY ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:ANNE
Last Name:GREER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 HARBISON DR STE A
Mailing Address - Street 2:SUITE 116
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3925
Mailing Address - Country:US
Mailing Address - Phone:530-848-6484
Mailing Address - Fax:
Practice Address - Street 1:555 MASON ST
Practice Address - Street 2:SUITE 260
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4612
Practice Address - Country:US
Practice Address - Phone:530-402-3708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 248271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000008462OtherMEDI-CAL PROVIDER NUMBER