Provider Demographics
NPI:1750709697
Name:TANNENBAUM, LOIS (PSYD)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:TANNENBAUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 HEATHER CIR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5730
Mailing Address - Country:US
Mailing Address - Phone:845-527-7913
Mailing Address - Fax:845-566-1215
Practice Address - Street 1:163 HEATHER CIR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5730
Practice Address - Country:US
Practice Address - Phone:845-527-7913
Practice Address - Fax:845-566-1215
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor