Provider Demographics
NPI:1902571565
Name:ESPINO, TIFFANY O
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:O
Last Name:ESPINO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 NAGLE AVE APT 54
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-1415
Mailing Address - Country:US
Mailing Address - Phone:917-593-8547
Mailing Address - Fax:
Practice Address - Street 1:2302 AVENUE U UNIT 290147
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-7504
Practice Address - Country:US
Practice Address - Phone:347-708-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1511046211101YS0200X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool