Provider Demographics
NPI:1790662666
Name:GUM, TIFFANY (LCSW, LCSW-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GUM
Suffix:
Gender:F
Credentials:LCSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-9207
Mailing Address - Country:US
Mailing Address - Phone:570-847-9268
Mailing Address - Fax:
Practice Address - Street 1:98 VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-9207
Practice Address - Country:US
Practice Address - Phone:570-847-9268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD340871041C0700X
FLTPSW26871041C0700X
PACW0195901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical