Healthcare Provider Details

I. General information

NPI: 1790662666
Provider Name (Legal Business Name): TIFFANY GUM LCSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 VALLEY VIEW RD
DANVILLE PA
17821-9207
US

IV. Provider business mailing address

98 VALLEY VIEW RD
DANVILLE PA
17821-9207
US

V. Phone/Fax

Practice location:
  • Phone: 570-847-9268
  • Fax:
Mailing address:
  • Phone: 570-847-9268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34087
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTPSW2687
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW019590
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: