Provider Demographics
NPI:1265067557
Name:MENARD, TIFFANY (LADC I)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MENARD
Suffix:
Gender:F
Credentials:LADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HIGHLAND CT
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1471
Mailing Address - Country:US
Mailing Address - Phone:508-558-6955
Mailing Address - Fax:
Practice Address - Street 1:25 OLD WESTPORT RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2537
Practice Address - Country:US
Practice Address - Phone:508-802-5289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)