Provider Demographics
NPI:1255153698
Name:TABITHA BRANDT-TIVEN, PHD - PSYCHOLOGIST, P.C.
Entity type:Organization
Organization Name:TABITHA BRANDT-TIVEN, PHD - PSYCHOLOGIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDT-TIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-713-3408
Mailing Address - Street 1:1723 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3347
Mailing Address - Country:US
Mailing Address - Phone:516-713-3408
Mailing Address - Fax:
Practice Address - Street 1:111 7TH ST UNIT 111
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5709
Practice Address - Country:US
Practice Address - Phone:516-713-3408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty