Provider Demographics
NPI:1699359919
Name:TANENBAUM, JULIA ROSE (LMSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ROSE
Last Name:TANENBAUM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 NEWCOMB PL
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-2003
Mailing Address - Country:US
Mailing Address - Phone:914-522-6558
Mailing Address - Fax:
Practice Address - Street 1:25 GERADA LN
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-3314
Practice Address - Country:US
Practice Address - Phone:914-522-6558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098394-011041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool