Provider Demographics
NPI:1154550150
Name:ROMER, TIFFANY ANNE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNE
Last Name:ROMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 HARRY HINES BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5216
Mailing Address - Country:US
Mailing Address - Phone:254-702-0957
Mailing Address - Fax:
Practice Address - Street 1:6300 HARRY HINES BLVD STE 900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5216
Practice Address - Country:US
Practice Address - Phone:214-456-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
TX561831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker