Provider Demographics
NPI:1275003642
Name:TANNENBAUM, BROOKE ALYSE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALYSE
Last Name:TANNENBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 SUNNY BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-3818
Mailing Address - Country:US
Mailing Address - Phone:925-354-9870
Mailing Address - Fax:
Practice Address - Street 1:4930 NAPLES ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3820
Practice Address - Country:US
Practice Address - Phone:619-276-1176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst