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General NPI Number Information
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NPI Number | 1932269099
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Entity Type | Individual
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Provider Name | TIFFANY SUSAN MOORE-CORTEVILLE LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 18 HARVARD ST STE 2
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City | ROCHESTER
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State | NY
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Zip | 14607-2607
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Country | US
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Telephone | 734-301-9346
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Fax |
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Provider Business Mailing Address
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Address Line | 16 THOMAS GRV
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City | PITTSFORD
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State | NY
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Zip | 14534-3066
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Country | US
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Telephone | 734-301-9346
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMSW 6801090559
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801090559
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW 19984
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LLMSW 6801090559
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 091298-01
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License Number State | NY
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