Provider Demographics
NPI:1396871695
Name:BAER, TIFFANY (LCSWA)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:BAER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6708 OLMSFORD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6454
Mailing Address - Country:US
Mailing Address - Phone:571-355-0440
Mailing Address - Fax:
Practice Address - Street 1:9541 JULIAN CLARK AVE STE 110
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3485
Practice Address - Country:US
Practice Address - Phone:980-358-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207221041C0700X, 104100000X
NCP0197391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker