| Tiffany Ann Avon Psy D Pc | |
|
585 Plandome Rd Ste 105 Manhasset NY 11030-1971 | |
| (917) 887-2783 | |
| Not Available |
| Full Name | Tiffany Ann Avon Psy D Pc |
|---|---|
| Speciality | Psychologist |
| Location | 585 Plandome Rd Ste 105, Manhasset, New York |
| Authorized Official Name and Position | Tiffany Avon (DIRECTOR) |
| Authorized Official Contact | 9178872783 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tiffany Ann Avon Psy D Pc 20 Canterbury Ln Ridgefield CT 06877-1102 Ph: () - | Tiffany Ann Avon Psy D Pc 585 Plandome Rd Ste 105 Manhasset NY 11030-1971 Ph: (917) 887-2783 |
| NPI Number | 1457833261 |
|---|---|
| Provider Enumeration Date | 08/29/2018 |
| Last Update Date | 05/20/2021 |
| Certification Date | 05/20/2021 |
| Medicare PECOS PAC ID | 0042612376 |
|---|---|
| Medicare Enrollment ID | O20210709000389 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457833261 | NPI | - | NPPES |
| 020146 | Other | NY | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 020146 (New York) | Primary |
| Provider Name | Tiffany Ann Avon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912364373 PECOS PAC ID: 3173815941 Enrollment ID: I20160714002151 |
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