Provider Demographics
NPI:1932636602
Name:LE, TIFFANY SAKRONA (MED)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SAKRONA
Last Name:LE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1937
Mailing Address - Country:US
Mailing Address - Phone:978-885-4678
Mailing Address - Fax:
Practice Address - Street 1:577 FOREST ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1937
Practice Address - Country:US
Practice Address - Phone:978-885-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health