Provider Demographics
NPI:1629204508
Name:TANNENBAUM, GLORIA P (PHD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:P
Last Name:TANNENBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-3904
Mailing Address - Country:US
Mailing Address - Phone:914-391-6785
Mailing Address - Fax:914-941-2002
Practice Address - Street 1:24 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-3904
Practice Address - Country:US
Practice Address - Phone:914-391-6785
Practice Address - Fax:914-941-2002
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010829-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist