Healthcare Provider Details

I. General information

NPI: 1013651900
Provider Name (Legal Business Name): TIFFANY MARIE MCCARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 COMMERCE BLVD
SCRANTON PA
18519-1759
US

IV. Provider business mailing address

324 WATER ST
HANOVER TOWNSHIP PA
18706-6034
US

V. Phone/Fax

Practice location:
  • Phone: 570-489-5561
  • Fax: 570-489-5563
Mailing address:
  • Phone: 570-855-2056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: