=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801442710
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE M TIGER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2019
-----------------------------------------------------
Last Update Date | 08/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 E GLENSIDE AVE STE B
-----------------------------------------------------
City | GLENSIDE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19038-4629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-308-4179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 305 BROOKDALE AVE FL 1
-----------------------------------------------------
City | GLENSIDE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19038-4506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-308-4179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW017899
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------