Provider Demographics
NPI:1801912886
Name:SMITH, TIFFANY L (MA)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FOSTER AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1162
Mailing Address - Country:US
Mailing Address - Phone:856-782-6749
Mailing Address - Fax:
Practice Address - Street 1:10 FOSTER AVE STE 1A
Practice Address - Street 2:
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1162
Practice Address - Country:US
Practice Address - Phone:856-782-6749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00654500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional