Provider Demographics
NPI:1457494049
Name:TANANBAUM, RONA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONA
Middle Name:L
Last Name:TANANBAUM
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 1:17 LOWE CIR
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-7632
Mailing Address - Country:US
Mailing Address - Phone:508-877-6825
Mailing Address - Fax:508-872-6722
Practice Address - Street 1:1 FRANKLIN COMMONS
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6619
Practice Address - Country:US
Practice Address - Phone:508-872-6610
Practice Address - Fax:508-872-6722
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3783103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03760OtherBLUECROSS BLUE SHIELD
MAW03760Medicare ID - Type Unspecified