Individual
PHYLLIS TIFFANY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0890000745
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00068810
BCBS
VT
05
—
1011769
—
VT
Enumeration date
11/14/2005
Last updated
04/11/2008
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