Tiffany Rae Noonan, LICSW, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

121870 Issued in MA

Practice address

204 Andover St Ste 403
Andover, MA 01810

Phone

(978) 272-9960

NPI assigned

Dec 12, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Tiffany Rae Horne Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572220800000",
    "number": "1124263637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 ANDOVER ST STE 403",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018105702",
            "telephone_number": "978-272-9960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 ANDOVER ST STE 403",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "01810",
            "telephone_number": "978-272-9960"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6 Kimball Ln Ste 310",
            "address_purpose": "LOCATION",
            "city": "Lynnfield",
            "state": "MA",
            "postal_code": "019402680",
            "country_code": "US",
            "telephone_number": "781-246-2010 x2086",
            "fax_number": "781-245-0953",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "204 Andover St Ste 403",
            "address_purpose": "LOCATION",
            "city": "Andover",
            "state": "MA",
            "postal_code": "01810",
            "country_code": "US",
            "telephone_number": "978-272-9960",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOONAN",
        "first_name": "TIFFANY",
        "middle_name": "RAE",
        "credential": "LICSW, MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-12",
        "last_updated": "2019-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "215303",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "000121870",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "121870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "HORNE",
            "middle_name": "RAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Andover, MA
• Providers in Andover, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.