Healthcare Provider Details

I. General information

NPI: 1962325951
Provider Name (Legal Business Name): TIFFANY L COLON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

55 SCHANCK RD # 77
FREEHOLD NJ
07728-2964
US

IV. Provider business mailing address

55 SCHANCK RD # 77
FREEHOLD NJ
07728-2964
US

V. Phone/Fax

Practice location:
  • Phone: 848-667-5313
  • Fax: 732-284-4834
Mailing address:
  • Phone: 732-820-9610
  • Fax: 732-284-4834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-474248
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: