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General NPI Number Information
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NPI Number | 1023143245
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Entity Type | Individual
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Provider Name | TIFFANY DEWITTE
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 1212 N CALIFORNIA ST
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City | STOCKTON
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State | CA
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Zip | 95202-1552
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Country | US
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Telephone | 209-468-7462
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Fax |
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Provider Business Mailing Address
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Address Line | 2750 ARGYLL AVE APT D
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City | CONCORD
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State | CA
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Zip | 94520-4768
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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