Basic Information
| Provider Information | |||||||||
| NPI: | 1386112373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRONIN | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 ACADEMY ST RM 201 | ||||||||
| Address2: | |||||||||
| City: | MAYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147571050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167534104 | ||||||||
| FaxNumber: | 7167534230 | ||||||||
| Practice Location | |||||||||
| Address1: | 319 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | DUNKIRK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140482137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163663550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2018 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 104294 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.