Provider Demographics
NPI:1649503616
Name:TANNENBAUM, DEBRA BETH (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:BETH
Last Name:TANNENBAUM
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 CREST RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-4049
Mailing Address - Country:US
Mailing Address - Phone:267-499-4419
Mailing Address - Fax:
Practice Address - Street 1:1520 CREST RD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-4049
Practice Address - Country:US
Practice Address - Phone:267-499-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional