Provider Demographics
NPI:1144962143
Name:FALTAS, TIFFANY (LSW, LCADC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:FALTAS
Suffix:
Gender:F
Credentials:LSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1507
Mailing Address - Country:US
Mailing Address - Phone:201-994-9476
Mailing Address - Fax:
Practice Address - Street 1:239 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-1401
Practice Address - Country:US
Practice Address - Phone:201-757-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00312800106H00000X
NJ44SL06762800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist