Provider Demographics
NPI:1710460845
Name:TANENBAUM, JASON BRYANT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRYANT
Last Name:TANENBAUM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HIGHPOINT DR STE 215
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3925
Mailing Address - Country:US
Mailing Address - Phone:215-491-1119
Mailing Address - Fax:215-491-9119
Practice Address - Street 1:200 HIGHPOINT DR STE 215
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3925
Practice Address - Country:US
Practice Address - Phone:215-491-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018620103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical