Provider Demographics
NPI:1992171870
Name:FUSE, TIFFANY (PHD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:FUSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHIMNEY POINT DRIVE
Mailing Address - Street 2:TRINITY BUILDING
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669
Mailing Address - Country:US
Mailing Address - Phone:315-541-2208
Mailing Address - Fax:315-541-2102
Practice Address - Street 1:1 CHIMNEY POINT DRIVE
Practice Address - Street 2:TRINITY BUILDING
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669
Practice Address - Country:US
Practice Address - Phone:315-541-2208
Practice Address - Fax:315-541-2102
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018879-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist