Provider Demographics
NPI:1447894688
Name:BARRY, TIFFANY LYN (LMSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LYN
Last Name:BARRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39378 FARMSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-4085
Mailing Address - Country:US
Mailing Address - Phone:787-308-3190
Mailing Address - Fax:
Practice Address - Street 1:23704 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:MARDELA SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:21837-2101
Practice Address - Country:US
Practice Address - Phone:410-742-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25564104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health