Healthcare Provider Details

I. General information

NPI: 1821653163
Provider Name (Legal Business Name): TIFFANY RICHARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W 38TH ST FL 6
NEW YORK NY
10018-9537
US

IV. Provider business mailing address

1341 E 87TH ST
BROOKLYN NY
11236-5135
US

V. Phone/Fax

Practice location:
  • Phone: 212-695-4564
  • Fax:
Mailing address:
  • Phone: 347-866-7537
  • 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: