Provider Demographics
NPI:1255051140
Name:TANZER, JAMIE SAGE SPEAR (LMHC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:SAGE SPEAR
Last Name:TANZER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 5TH AVE STE 604-605
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4509
Mailing Address - Country:US
Mailing Address - Phone:978-245-7105
Mailing Address - Fax:
Practice Address - Street 1:276 5TH AVE STE 604-605
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4509
Practice Address - Country:US
Practice Address - Phone:978-245-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP116916101YM0800X
NY014594101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP116916OtherLIMITED PERMIT NUMBER
NY014594OtherLICENSE NUMBER