Provider Demographics
NPI:1003877671
Name:LINDENBAUM, DENNIS BRUCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:BRUCE
Last Name:LINDENBAUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 FOX HOLLOW PKWY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2406
Mailing Address - Country:US
Mailing Address - Phone:770-578-0046
Mailing Address - Fax:
Practice Address - Street 1:789 FOX HOLLOW PKWY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2406
Practice Address - Country:US
Practice Address - Phone:770-578-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001011103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBDRZMedicare ID - Type Unspecified