Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 35SI00470500 | NJ |
Y | 103TC1900X | Counseling Psychologist | 35SI00470500 | NJ |
NPI | 1003131269 |
---|---|
Provider Name | Dr. Ilana Tannenbaum |
First Address | Bloomfield, NJ 07003-4946 |
Second Address | Montclair, NJ 07042-3455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2010 |
Last Update Date | 31/03/2010 |