Healthcare Provider Details

I. General information

NPI: 1447894688
Provider Name (Legal Business Name): TIFFANY LYN BARRY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23704 OCEAN GTWY
MARDELA SPRINGS MD
21837-2101
US

IV. Provider business mailing address

39378 FARMSTEAD RD
SELBYVILLE DE
19975-4085
US

V. Phone/Fax

Practice location:
  • Phone: 410-742-7400
  • Fax:
Mailing address:
  • Phone: 787-308-3190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25564
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number25564
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: