Provider Demographics
NPI:1669483954
Name:DANNENBAUM, SANDRA M (PHD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:DANNENBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 S MCCLINTOCK DR
Mailing Address - Street 2:SUITE 103-174
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1695
Mailing Address - Country:US
Mailing Address - Phone:480-452-4797
Mailing Address - Fax:480-264-2763
Practice Address - Street 1:7650 S MCCLINTOCK DR
Practice Address - Street 2:SUITE 103-174
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1695
Practice Address - Country:US
Practice Address - Phone:480-452-4797
Practice Address - Fax:480-718-7859
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3828103TC1900X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ128424Medicaid
AZZ135280Medicare PIN