Healthcare Provider Details

I. General information

NPI: 1033782818
Provider Name (Legal Business Name): TIFFANY GRIFFIN ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7821 RALEIGH ST
HOLLYWOOD FL
33024-2531
US

IV. Provider business mailing address

7821 RALEIGH ST
HOLLYWOOD FL
33024-2531
US

V. Phone/Fax

Practice location:
  • Phone: 301-788-2278
  • Fax:
Mailing address:
  • Phone: 301-788-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberSS1489
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberSS1489
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberSS1489
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberSS1489
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberSS1489
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberSS1489
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1489
License Number StateFL
# 8
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberSS1489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: