Provider Demographics
NPI:1609760008
Name:TANNEN, SAGE MORNINGSTAR
Entity type:Individual
Prefix:
First Name:SAGE
Middle Name:MORNINGSTAR
Last Name:TANNEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17347 N SETON AVE
Mailing Address - Street 2:
Mailing Address - City:EMMITSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21727-9157
Mailing Address - Country:US
Mailing Address - Phone:812-797-0359
Mailing Address - Fax:
Practice Address - Street 1:343 S SETON AVE
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727-9226
Practice Address - Country:US
Practice Address - Phone:301-447-5090
Practice Address - Fax:301-682-5247
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician