Provider Demographics
NPI:1548047483
Name:SAVAGE, TIFFANY S (PSYD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:S
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:S
Other - Last Name:SAVAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:450 PITTMAN RD APT 724
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-6733
Mailing Address - Country:US
Mailing Address - Phone:323-365-4677
Mailing Address - Fax:
Practice Address - Street 1:2420 MARTIN RD STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-8610
Practice Address - Country:US
Practice Address - Phone:707-770-9717
Practice Address - Fax:707-399-4521
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSB94027289103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist