Provider Demographics
NPI:1710070032
Name:TENENBAUM, PH.D., HENRY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:A
Last Name:TENENBAUM, PH.D.
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 1:252 CHARTLEY CT N
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1670
Mailing Address - Country:US
Mailing Address - Phone:941-737-4878
Mailing Address - Fax:941-342-6277
Practice Address - Street 1:252 CHARTLEY CT N
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1670
Practice Address - Country:US
Practice Address - Phone:941-737-4878
Practice Address - Fax:941-342-6277
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004871103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist