Provider Demographics
NPI:1942855143
Name:BORGES, TIFFANIE A (LAC, NCC)
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:A
Last Name:BORGES
Suffix:
Gender:F
Credentials:LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7220
Mailing Address - Country:US
Mailing Address - Phone:732-593-9872
Mailing Address - Fax:
Practice Address - Street 1:1198 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2237
Practice Address - Country:US
Practice Address - Phone:732-736-6559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00475800101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor