Provider Demographics
NPI:1508674615
Name:GHANNIE, TIFFANY ALLEZA (LMHC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ALLEZA
Last Name:GHANNIE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-1128
Mailing Address - Country:US
Mailing Address - Phone:917-280-5880
Mailing Address - Fax:
Practice Address - Street 1:1124 ROUTE 94 STE 201
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7277
Practice Address - Country:US
Practice Address - Phone:845-787-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health