| Doctor Name: | PHYLLIS TIFFANY |
| NPI Number: | 1104807486 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 0890000745 |
| Business Practice Address: | 44 Main St Suite 200 Richford, VT - 054761153 |
| Business Phone Number: | 8022555500 |
| Business Fax Number: | 8022555509 |
| Mailing Address: | 207 Corliss Rd, RICHFORD |
| State: | VT |
| Postal Code: | 054761259 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/14/2005 |
| NPI Last Update Date: | 04/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 0890000745 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |