Provider Demographics
NPI:1437500857
Name:TENNENBAUM, DAWN (PHD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:TENNENBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:627 N LARCHMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1307
Mailing Address - Country:US
Mailing Address - Phone:424-422-1010
Mailing Address - Fax:
Practice Address - Street 1:627 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1307
Practice Address - Country:US
Practice Address - Phone:424-422-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical