Provider Demographics
NPI:1962168690
Name:MONTAQUE-JENKINS, TIFFANNIE
Entity type:Individual
Prefix:
First Name:TIFFANNIE
Middle Name:
Last Name:MONTAQUE-JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7527 W LINNE RD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-9290
Mailing Address - Country:US
Mailing Address - Phone:510-564-6999
Mailing Address - Fax:
Practice Address - Street 1:7527 W LINNE RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-9290
Practice Address - Country:US
Practice Address - Phone:510-564-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1356201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical