Provider Demographics
NPI:1669676540
Name:TANNA, RENUKA ATI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:ATI
Last Name:TANNA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SOMERSET ST
Mailing Address - Street 2:SUITE 2111
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-4800
Mailing Address - Country:US
Mailing Address - Phone:732-832-9604
Mailing Address - Fax:
Practice Address - Street 1:2237 KELMSCOTT CT
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3536
Practice Address - Country:US
Practice Address - Phone:732-832-9604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32776103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical