Provider Demographics
NPI:1922860220
Name:RICHARDSON, TIFFANY MILAGROS (LMSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MILAGROS
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 VANDALIA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-2816
Mailing Address - Country:US
Mailing Address - Phone:347-982-4247
Mailing Address - Fax:
Practice Address - Street 1:275 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1611
Practice Address - Country:US
Practice Address - Phone:212-420-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119816104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker