Provider Demographics
NPI:1700242237
Name:PUNDAI, TIFFANY (LCSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:PUNDAI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:BAER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:622 VINE ST
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3639
Mailing Address - Country:US
Mailing Address - Phone:724-961-0408
Mailing Address - Fax:
Practice Address - Street 1:622 VINE ST
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3639
Practice Address - Country:US
Practice Address - Phone:724-961-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0185551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical