Provider Demographics
NPI:1760654396
Name:BAUER, TIFFANY (MA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 THORN AVE
Mailing Address - Street 2:BOX 631
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2600
Mailing Address - Country:US
Mailing Address - Phone:716-662-2040
Mailing Address - Fax:716-662-0019
Practice Address - Street 1:2309 EGGERT RD
Practice Address - Street 2:SUITE 9
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9200
Practice Address - Country:US
Practice Address - Phone:716-831-1856
Practice Address - Fax:716-831-0263
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health