Provider Demographics
NPI:1336874155
Name:KAELIN, TIFFANY LEE (LMFT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEE
Last Name:KAELIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BROADWAY APT 201
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2610
Mailing Address - Country:US
Mailing Address - Phone:203-751-1188
Mailing Address - Fax:401-247-8379
Practice Address - Street 1:207 BROADWAY APT 201
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2610
Practice Address - Country:US
Practice Address - Phone:203-751-1188
Practice Address - Fax:401-247-8379
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMFT00252101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health