Provider Demographics
NPI:1093343394
Name:TENENBAUM, SHAINA LEAH (BA)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:LEAH
Last Name:TENENBAUM
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 CLAY AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2141
Mailing Address - Country:US
Mailing Address - Phone:216-224-8729
Mailing Address - Fax:
Practice Address - Street 1:851 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1759
Practice Address - Country:US
Practice Address - Phone:570-489-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical