Provider Demographics
NPI:1558458299
Name:TEPPER, BRENDA
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:TEPPER
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 1:300 CENTRAL PARK WEST
Mailing Address - Street 2:#3J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-595-0559
Mailing Address - Fax:212-787-9407
Practice Address - Street 1:300 CENTRAL PARK WEST
Practice Address - Street 2:#3J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-595-0559
Practice Address - Fax:212-787-9407
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004116PSYCHOLOGY103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV19821Medicare ID - Type Unspecified