Provider Demographics
NPI:1831646868
Name:TANNENBAUM, RICKI (LMSW)
Entity Type:Individual
Prefix:MS
First Name:RICKI
Middle Name:
Last Name:TANNENBAUM
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 1:334 E 148TH ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5707
Mailing Address - Country:US
Mailing Address - Phone:718-401-5050
Mailing Address - Fax:
Practice Address - Street 1:334 E 148TH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5707
Practice Address - Country:US
Practice Address - Phone:718-401-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098126-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker