Provider Demographics
NPI:1366057192
Name:VENEGAS, TIFFANY AMBER (MSW, ACSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:AMBER
Last Name:VENEGAS
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 ESTERS BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2233
Mailing Address - Country:US
Mailing Address - Phone:415-424-4266
Mailing Address - Fax:415-520-6633
Practice Address - Street 1:10775 PIONEER TRL STE 215
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0234
Practice Address - Country:US
Practice Address - Phone:415-424-4266
Practice Address - Fax:415-520-6633
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 172V00000X, 104100000X
CA1090821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical