Provider Demographics
NPI:1457995995
Name:WRIGHT, TIFFANY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 SANTA ROSALIA DR # 1012
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3603
Mailing Address - Country:US
Mailing Address - Phone:310-431-9003
Mailing Address - Fax:
Practice Address - Street 1:3907 W 111TH ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2140
Practice Address - Country:US
Practice Address - Phone:310-431-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA818231041C0700X
CA1017901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA