Healthcare Provider Details

I. General information

NPI: 1205766409
Provider Name (Legal Business Name): HALEY TIFFANY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 ELM ST
DEDHAM MA
02026-4530
US

IV. Provider business mailing address

18 HARRIS AVE APT 2
BOSTON MA
02130-2848
US

V. Phone/Fax

Practice location:
  • Phone: 781-214-6590
  • Fax:
Mailing address:
  • Phone: 774-808-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: