MEDICARE: TIFFANY MARIE COOTWARE-WILLIAMS 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
1	1041C0700X	Clinical Social Worker	SW23713	FL

General Provider Information

NPI Number	:	1669288478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY MARIE COOTWARE-WILLIAMS LCSW

Provider Business Mailing Address
First Line	:	17662 SADDLEBACK LOOP
Second Line	:
City	:	N FT MYERS
State	:	FL
Zip	:	33917-3754
Country	:	US
Telephone Number	:	239-878-9231
Fax Number	:

Provider Business Practice Location Address
First Line	:	17662 SADDLEBACK LOOP
Second Line	:
City	:	N FT MYERS
State	:	FL
Zip	:	33917-3754
Country	:	US
Telephone Number	:	239-878-9231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	12/06/2024

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