Provider Demographics
NPI:1477751279
Name:BLAND, TANYA
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:BLAND
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 1:3900 CITY AVE
Mailing Address - Street 2:MADISON D307
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2908
Mailing Address - Country:US
Mailing Address - Phone:215-877-7465
Mailing Address - Fax:215-883-2010
Practice Address - Street 1:3900 CITY AVE
Practice Address - Street 2:MADISON D307
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2908
Practice Address - Country:US
Practice Address - Phone:215-877-7465
Practice Address - Fax:215-883-2010
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist