Provider Demographics
NPI:1891192308
Name:DELL'AQUILA, TIFFANY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:DELL'AQUILA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3592
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-0592
Mailing Address - Country:US
Mailing Address - Phone:773-255-4200
Mailing Address - Fax:
Practice Address - Street 1:1711 N CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5602
Practice Address - Country:US
Practice Address - Phone:773-255-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008018103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical