Healthcare Provider Details

I. General information

NPI: 1295211464
Provider Name (Legal Business Name): TIFFANY CIPRIAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 W 22ND ST
NEW YORK NY
10010-5805
US

IV. Provider business mailing address

2 ALDON TER
BLOOMFIELD NJ
07003-2902
US

V. Phone/Fax

Practice location:
  • Phone: 646-818-9921
  • Fax:
Mailing address:
  • Phone: 917-216-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number083791
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: