Doctor Name: | TIFFANY LECATOR |
NPI Number: | 1366840985 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 828 Blackwood Clementon Rd Apt 104 Pine Hill, NJ - 080216819 |
Business Phone Number: | 8562654928 |
Business Fax Number: | |
Mailing Address: | 828 Blackwood Clementon Rd Apt 104, PINE HILL |
State: | NJ |
Postal Code: | 080216819 |
Phone Number: | 8562654928 |
Fax Number: | |
NPI Enumeration Date: | 12/13/2014 |
NPI Last Update Date: | 12/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |