Provider Demographics
NPI:1134427842
Name:RICHARD, TIFFANY NOEL (MA)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:NOEL
Last Name:RICHARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4434
Mailing Address - Country:US
Mailing Address - Phone:401-261-8871
Mailing Address - Fax:
Practice Address - Street 1:2425 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-4508
Practice Address - Country:US
Practice Address - Phone:508-679-8511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5842101YM0800X
RI00459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health