Provider Demographics
NPI:1699172833
Name:OPPENHEIM, TIFFANI (MA)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:OPPENHEIM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5284 ADOLFO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-6787
Mailing Address - Country:US
Mailing Address - Phone:805-289-0120
Mailing Address - Fax:805-289-0130
Practice Address - Street 1:5284 ADOLFO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-6787
Practice Address - Country:US
Practice Address - Phone:805-289-0120
Practice Address - Fax:805-289-0130
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health