Provider Demographics
NPI:1932562162
Name:PAGE, TIFFANY (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:D
Other - Last Name:BARTHELEMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-0315
Mailing Address - Country:US
Mailing Address - Phone:862-220-8419
Mailing Address - Fax:
Practice Address - Street 1:210 CHESTNUT ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-2732
Practice Address - Country:US
Practice Address - Phone:862-220-8419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00236700101YA0400X
10075901041S0200X
NJ44SC057486001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty