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NPI Code Detail

MEDICARE: TIFFANY JACKSON LSCW

MEDICARE: TIFFANY JACKSON LSCW
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 Worker44SC05840600NJ

General Provider Information

NPI Number : 1639728413
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY JACKSON LSCW
Provider Business Mailing Address
First Line : 300 CARNEGIE CTR STE 150
Second Line :
City : PRINCETON
State : NJ
Zip : 08540-6285
Country : US
Telephone Number : 609-831-3979
Fax Number :
Provider Business Practice Location Address
First Line : 300 CARNEGIE CTR STE 150
Second Line :
City : PRINCETON
State : NJ
Zip : 08540-6285
Country : US
Telephone Number : 609-831-3979
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2019
Last Update Date : 12/08/2025

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