Provider Demographics
NPI:1639133093
Name:TANNENBAUM, ALLAN N (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:N
Last Name:TANNENBAUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2667
Mailing Address - Country:US
Mailing Address - Phone:610-667-9830
Mailing Address - Fax:610-667-9866
Practice Address - Street 1:915 MONTGOMERY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1548
Practice Address - Country:US
Practice Address - Phone:610-667-9830
Practice Address - Fax:610-667-9866
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003039L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA114835Medicare ID - Type Unspecified