Provider Demographics
NPI:1659644060
Name:TANTIA, JENNIFER FRANK (PHD, BC-DMT, LCAT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:FRANK
Last Name:TANTIA
Suffix:
Gender:F
Credentials:PHD, BC-DMT, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W 40TH ST
Mailing Address - Street 2:#403
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-1504
Mailing Address - Country:US
Mailing Address - Phone:646-591-4017
Mailing Address - Fax:
Practice Address - Street 1:202 W 40TH ST
Practice Address - Street 2:#403
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1504
Practice Address - Country:US
Practice Address - Phone:646-591-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000372-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health