Healthcare Provider Details

I. General information

NPI: 1881195642
Provider Name (Legal Business Name): TIFFANY M CAMPBELL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. TIFFANY MARIE HARRIS

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 TAYLORS MILLS RD
MANALAPAN NJ
07726-3255
US

IV. Provider business mailing address

9 LAKE AVE APT 5B
EAST BRUNSWICK NJ
08816-1820
US

V. Phone/Fax

Practice location:
  • Phone: 908-415-2042
  • Fax:
Mailing address:
  • Phone: 347-882-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37FI00185500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: