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NPI Code Detail

MEDICARE: TIFFANY TAIT LCSW

MEDICARE: TIFFANY TAIT LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerSW11409FL

General Provider Information

NPI Number : 1215302534
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY TAIT LCSW
Provider Business Mailing Address
First Line : 1431 SW 9TH AVE
Second Line :
City : DEERFIELD BEACH
State : FL
Zip : 33441-6220
Country : US
Telephone Number : 954-384-5099
Fax Number :
Provider Business Practice Location Address
First Line : 1431 SW 9TH AVE
Second Line :
City : DEERFIELD BEACH
State : FL
Zip : 33441-6220
Country : US
Telephone Number : 954-384-5099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2015
Last Update Date : 12/11/2015

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Directions to “ TIFFANY TAIT LCSW” Practice Location

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