Healthcare Provider Details

I. General information

NPI: 1235047184
Provider Name (Legal Business Name): TIFFANY MYRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 NEW JERSEY AVE
BROOKLYN NY
11207-7006
US

IV. Provider business mailing address

818 NEW JERSEY AVE
BROOKLYN NY
11207-7006
US

V. Phone/Fax

Practice location:
  • Phone: 917-757-9628
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: