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NPI Code Detail

MEDICARE: TIFFANY OLIVAREZ MS, LMHC, MCAP

MEDICARE: TIFFANY OLIVAREZ MS, LMHC, MCAP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorMH13193FL
2251S00000XCommunity/Behavioral Health AgencyMH13193FL

General Provider Information

NPI Number : 1124492525
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY OLIVAREZ MS, LMHC, MCAP
Provider Business Mailing Address
First Line : 2198 HARRIS AVE NE
Second Line :
City : PALM BAY
State : FL
Zip : 32905-4002
Country : US
Telephone Number : 321-951-9750
Fax Number :
Provider Business Practice Location Address
First Line : 2198 HARRIS AVE NE
Second Line :
City : PALM BAY
State : FL
Zip : 32905-4002
Country : US
Telephone Number : 321-951-9750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2015
Last Update Date : 11/23/2015

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