Provider Demographics
NPI:1043644669
Name:BEAN, SHANNA TIFFANY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:TIFFANY
Last Name:BEAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHANNA
Other - Middle Name:TIFFANY
Other - Last Name:GERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:146 CENTRAL PARK WEST
Mailing Address - Street 2:SUITE 1 D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:917-740-4280
Mailing Address - Fax:212-459-1520
Practice Address - Street 1:146 CENTRAL PARK WEST
Practice Address - Street 2:SUITE 1 D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:917-740-4280
Practice Address - Fax:212-459-1520
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020918103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical