Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 085439-1 | NY |
NPI | 1003209362 |
---|---|
Provider Name | Tiffany St. Louis |
First Address | Glens Falls, NY 12801-2357 |
Second Address | Glens Falls, NY 12801-3617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2015 |
Last Update Date | 27/12/2017 |