Provider Demographics
NPI:1790591980
Name:JEFFREY, TIFFANIE MARIE
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:MARIE
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 DELA VINA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3966
Mailing Address - Country:US
Mailing Address - Phone:916-753-3868
Mailing Address - Fax:
Practice Address - Street 1:451 DELA VINA AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3966
Practice Address - Country:US
Practice Address - Phone:916-753-3868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician