Healthcare Provider Details

I. General information

NPI: 1205756301
Provider Name (Legal Business Name): TIFFANY REEVES MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 CARLTON ST
EAST ORANGE NJ
07017-2309
US

IV. Provider business mailing address

48 CARLTON ST
EAST ORANGE NJ
07017-2309
US

V. Phone/Fax

Practice location:
  • Phone: 862-234-9525
  • Fax:
Mailing address:
  • Phone: 862-234-9525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC06657900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: