Healthcare Provider Details

I. General information

NPI: 1932023322
Provider Name (Legal Business Name): TIFFANI ROONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BLACKBIRD LN
HUMMELSTOWN PA
17036-8865
US

IV. Provider business mailing address

710 W CHOCOLATE AVE # 1013
HERSHEY PA
17033-1942
US

V. Phone/Fax

Practice location:
  • Phone: 717-979-5770
  • Fax:
Mailing address:
  • Phone: 717-979-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC018152
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: