Provider Demographics
NPI:1841365228
Name:TANNAR, EDITH K (LCSW CASAC)
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:K
Last Name:TANNAR
Suffix:
Gender:F
Credentials:LCSW CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 JONES RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990
Mailing Address - Country:US
Mailing Address - Phone:845-986-0439
Mailing Address - Fax:
Practice Address - Street 1:18 JONES RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990
Practice Address - Country:US
Practice Address - Phone:845-986-0439
Practice Address - Fax:845-986-7472
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP0S392211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11624563OtherCAQH