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General NPI Number Information
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NPI Number | 1205587292
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Entity Type | Individual
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Provider Name | TIFFANY DANIELLE MACK LSW
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Gender | Female
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 151 KNOLLCROFT RD BLDG 53
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City | LYONS
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State | NJ
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Zip | 07939-5001
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Country | US
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Telephone | 908-647-0180
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Fax | 908-604-5836
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Provider Business Mailing Address
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Address Line | 7000 AVALON WAY APT 7436
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City | PISCATAWAY
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State | NJ
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Zip | 08854-7026
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Country | US
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Telephone | 908-295-9888
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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 | 44SC06232300
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License Number State | NJ
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