Provider Demographics
NPI:1023199866
Name:TANOWITZ, MEREDITH LISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:LISA
Last Name:TANOWITZ
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 1:40 SPRING LN
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-2608
Mailing Address - Country:US
Mailing Address - Phone:914-299-1377
Mailing Address - Fax:914-238-9084
Practice Address - Street 1:245 N BROADWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2670
Practice Address - Country:US
Practice Address - Phone:914-299-1377
Practice Address - Fax:914-238-9084
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015331-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ27607Medicare UPIN
NYVM5831Medicare ID - Type Unspecified