Provider Demographics
NPI:1801577739
Name:SULSER, TIFFANY DONNA (LCSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DONNA
Last Name:SULSER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79-01 BROADWAY
Mailing Address - Street 2:DEPT OF SOCIAL WORK A1-25
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-334-2650
Mailing Address - Fax:718-334-1411
Practice Address - Street 1:79-01 BROADWAY
Practice Address - Street 2:DEPT OF SOCIAL WORK A1-25
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-334-2650
Practice Address - Fax:718-334-1411
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0838541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical