Provider Demographics
NPI:1891845053
Name:TANENBAUM, CINDY ANN (PHD, CSW)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:ANN
Last Name:TANENBAUM
Suffix:
Gender:F
Credentials:PHD, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 ROCKINGSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1219
Mailing Address - Country:US
Mailing Address - Phone:914-834-5107
Mailing Address - Fax:
Practice Address - Street 1:265 ROCKINGSTONE AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-1219
Practice Address - Country:US
Practice Address - Phone:914-834-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR030702-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7404828OtherGHI NUMBER
NY1059910OtherBEACON NUMBER
NYN36550OtherBLUE CROSS BLUE SHEILD
NY197012OtherMHN
NY126057OtherVALUE BEHAVIORAL HEALTH
NY197012OtherMHN