Provider Demographics
NPI:1821220161
Name:HERBERT, TIFFANY KATHLEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:KATHLEEN
Last Name:HERBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ROSECRANS AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3708
Mailing Address - Country:US
Mailing Address - Phone:310-321-7814
Mailing Address - Fax:310-672-7717
Practice Address - Street 1:1600 ROSECRANS AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3708
Practice Address - Country:US
Practice Address - Phone:310-321-7814
Practice Address - Fax:310-672-7717
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21630103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical