Provider Demographics
NPI:1891033270
Name:TAYLOR-MOODY, TIFFANY MONIQUE (MS ED)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MONIQUE
Last Name:TAYLOR-MOODY
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:MONIQUE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:319 WILSON AVE
Mailing Address - Street 2:3E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-5168
Mailing Address - Country:US
Mailing Address - Phone:347-720-3212
Mailing Address - Fax:
Practice Address - Street 1:319 WILSON AVE
Practice Address - Street 2:3E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5168
Practice Address - Country:US
Practice Address - Phone:347-720-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-20
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst