Provider Demographics
NPI:1790247161
Name:HARNETT, TIFFANY BURBIDGE (LCSW, ACHP-SW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:BURBIDGE
Last Name:HARNETT
Suffix:
Gender:F
Credentials:LCSW, ACHP-SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 SW 1ST PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4503
Mailing Address - Country:US
Mailing Address - Phone:239-313-9732
Mailing Address - Fax:
Practice Address - Street 1:3006 SW 1ST PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4503
Practice Address - Country:US
Practice Address - Phone:239-313-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW129991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical