Provider Demographics
NPI:1902323728
Name:LEMON, TIFFANY A (MSW,LISW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:LEMON
Suffix:
Gender:F
Credentials:MSW,LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-3147
Mailing Address - Country:US
Mailing Address - Phone:740-454-1266
Mailing Address - Fax:
Practice Address - Street 1:1127 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3147
Practice Address - Country:US
Practice Address - Phone:740-454-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22038031041C0700X
OHS.1701169104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268289Medicaid