Provider Demographics
NPI:1124492525
Name:OLIVAREZ, TIFFANY (MS, LMHC, MCAP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:OLIVAREZ
Suffix:
Gender:F
Credentials:MS, LMHC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2198 HARRIS AVE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4002
Mailing Address - Country:US
Mailing Address - Phone:321-951-9750
Mailing Address - Fax:
Practice Address - Street 1:2198 HARRIS AVE NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4002
Practice Address - Country:US
Practice Address - Phone:321-951-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13193101YA0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251S00000XAgenciesCommunity/Behavioral Health