Individual ProviderTiffany ClarkSocial WorkerBehavioral Health & Social Service ProvidersPractice Address1430 Main St, Waltham, MA 02451-1623(781) 647-5327(617) 935-5156PECOS EnrollmentBased on the most recent information from CMS, provider Tiffany Clark does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:04 AM.Profile DetailsProvider ID1467934240Provider TypeIndividualFull NameClark, TiffanyGenderFemaleSole ProprietorNoEnumeration Date8/29/2018Last Updated8/29/2018Contact InformationPractice LocationPractice Address1430 Main St, Waltham, MA 02451-1623Phone(781) 647-5327FaxUnlisted FaxMailing LocationMailing Address23 Village Rock Ln Apt 21, Natick, MA 01760-5715Phone(617) 935-5156FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense120811Massachusetts