Basic Information
| Provider Information | |||||||||
| NPI: | 1891337549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITHSON | ||||||||
| FirstName: | TIFFANI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 267 KENTLANDS BLVD STE 5206 | ||||||||
| Address2: | |||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208785446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2408555428 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 267 KENTLANDS BLVD # 5206 | ||||||||
| Address2: | |||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208785446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2408555428 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2019 | ||||||||
| LastUpdateDate: | 06/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LC50081082 | DC | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 14063 | SC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LC50081082 | DC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 17808 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 0522 | 01 | MD | COMMERCIAL | OTHER |