Provider Demographics
NPI:1356427645
Name:BRANDWEIN, TARA R (PSYD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:R
Last Name:BRANDWEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 CAPE MAY ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4721
Mailing Address - Country:US
Mailing Address - Phone:201-541-5535
Mailing Address - Fax:
Practice Address - Street 1:446 CAPE MAY ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4721
Practice Address - Country:US
Practice Address - Phone:201-541-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100432800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0090581Medicaid
NJ097956Medicare ID - Type Unspecified