Individual
KELLY TIFFANY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
74 BRICK BLVD, BRICK, NJ 08723-7984
(732) 451-4531
Mailing address
2011 RTE 71, SPRING LAKE, NJ 07762-2214
(908) 721-7255
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL06380900
NJ
Other
Enumeration date
02/06/2023
Last updated
02/06/2023
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