Provider Demographics
NPI:1992230098
Name:WHITE, TIFFANY MARIE (LICSW,AAP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LICSW,AAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:WELLS RIVER
Mailing Address - State:VT
Mailing Address - Zip Code:05081-9692
Mailing Address - Country:US
Mailing Address - Phone:802-757-2325
Mailing Address - Fax:
Practice Address - Street 1:65 MAIN ST N
Practice Address - Street 2:
Practice Address - City:WELLS RIVER
Practice Address - State:VT
Practice Address - Zip Code:05081-9692
Practice Address - Country:US
Practice Address - Phone:802-757-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical