Healthcare Provider Details

I. General information

NPI: 1194432401
Provider Name (Legal Business Name): TIFFANY MIREYA YEPEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W 17TH ST
NEW YORK NY
10011-5325
US

IV. Provider business mailing address

287 DEVOE ST APT 3L
BROOKLYN NY
11211-2626
US

V. Phone/Fax

Practice location:
  • Phone: 212-206-5200
  • Fax:
Mailing address:
  • Phone: 917-832-0548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: