Provider Demographics
NPI:1932269099
Name:MOORE-CORTEVILLE, TIFFANY SUSAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:SUSAN
Last Name:MOORE-CORTEVILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 THOMAS GRV
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3066
Mailing Address - Country:US
Mailing Address - Phone:734-301-9346
Mailing Address - Fax:
Practice Address - Street 1:18 HARVARD ST STE 2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2607
Practice Address - Country:US
Practice Address - Phone:734-301-9346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILMSW 6801090559101YM0800X
MI6801090559104100000X
CAASW 19984101YM0800X
MILLMSW 6801090559101YM0800X
NY091298-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801090559OtherMICHIGAN DEPT OF COMMUNITY HEALTH
CA19984OtherASW REGISTRATION NUMBER
2781209OtherUNIVERSITY OF THE STATE OF NEW YORK, EDUCATION DEPARTMENT, OFFICE OF PROFESSIONS