Healthcare Provider Details

I. General information

NPI: 1114320413
Provider Name (Legal Business Name): TIFFANY ABREGO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25882 ORCHARD LAKE RD STE L-1
FARMINGTON HILLS MI
48336-1269
US

IV. Provider business mailing address

31925 STAMAN CT
FARMINGTON HILLS MI
48336-1867
US

V. Phone/Fax

Practice location:
  • Phone: 313-444-2630
  • Fax:
Mailing address:
  • Phone: 951-544-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number071.009388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: