Healthcare Provider Details

I. General information

NPI: 1245972819
Provider Name (Legal Business Name): TIFFANIE RODRIGUEZ CARRIER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANIE RODRIGUEZ LICSW

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CUMMINGS CTR STE 3100
BEVERLY MA
01915-6540
US

IV. Provider business mailing address

500 CUMMINGS CTR STE 3100
BEVERLY MA
01915-6540
US

V. Phone/Fax

Practice location:
  • Phone: 978-222-3121
  • Fax:
Mailing address:
  • Phone: 626-224-1428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW215945
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: