Provider Demographics
NPI:1942405733
Name:SPERLING TENNENBERG, SHOSHANA (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHOSHANA
Middle Name:
Last Name:SPERLING TENNENBERG
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 1:4 MCNEAL CT
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3665
Mailing Address - Country:US
Mailing Address - Phone:973-243-0246
Mailing Address - Fax:
Practice Address - Street 1:33-01 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4324
Practice Address - Country:US
Practice Address - Phone:917-446-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100429500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist