Provider Demographics
NPI:1629897137
Name:BENNETT, TIFFANY NICOLE (BSW, MSW, LSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICOLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:BSW, MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ORLY WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-3434
Mailing Address - Country:US
Mailing Address - Phone:609-694-0070
Mailing Address - Fax:
Practice Address - Street 1:1289 ROUTE 38 STE 203
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2730
Practice Address - Country:US
Practice Address - Phone:609-267-1377
Practice Address - Fax:609-265-9268
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07084700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker