Provider Demographics
NPI:1124263637
Name:NOONAN, TIFFANY RAE (LICSW, MSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RAE
Last Name:NOONAN
Suffix:
Gender:F
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:RAE
Other - Last Name:HORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 ANDOVER ST STE 403
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-5702
Mailing Address - Country:US
Mailing Address - Phone:978-272-9960
Mailing Address - Fax:
Practice Address - Street 1:204 ANDOVER ST STE 403
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810
Practice Address - Country:US
Practice Address - Phone:978-272-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2153031041C0700X
MA0001218701041C0700X
MA1218701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical