Provider Demographics
NPI:1932757697
Name:TANE, MYOSHA (LMSW)
Entity Type:Individual
Prefix:
First Name:MYOSHA
Middle Name:
Last Name:TANE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 N 10TH ST STE 312
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-9318
Mailing Address - Country:US
Mailing Address - Phone:646-779-7172
Mailing Address - Fax:
Practice Address - Street 1:190 N 10TH ST STE 312
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-9318
Practice Address - Country:US
Practice Address - Phone:646-779-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health