Individual
TIFFANY LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16 LUCAS AVE STE 201, KINGSTON, NY 12401-3708
(845) 514-2094
Mailing address
401 VANDALE RD, WEST HURLEY, NY 12491-5313
(845) 416-1853
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
11/29/2021
Last updated
11/29/2021
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