Provider Demographics
NPI:1679094429
Name:LOPEZ, TIFFANY LORI (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LORI
Last Name:LOPEZ
Suffix:
Gender:
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4961 OVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8711
Mailing Address - Country:US
Mailing Address - Phone:320-406-7608
Mailing Address - Fax:
Practice Address - Street 1:4961 OVERLAND DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8711
Practice Address - Country:US
Practice Address - Phone:320-406-7608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-02
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA613661701041C0700X
NV11166-C1041C0700X
TN86911041C0700X
IN34011719A1041C0700X
MN266711041C0700X
ME216421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical