Healthcare Provider Details

I. General information

NPI: 1669483954
Provider Name (Legal Business Name): SANDRA M. DANNENBAUM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 S MCCLINTOCK DR SUITE 103-174
TEMPE AZ
85284-1695
US

IV. Provider business mailing address

7650 S MCCLINTOCK DR SUITE 103-174
TEMPE AZ
85284-1695
US

V. Phone/Fax

Practice location:
  • Phone: 480-452-4797
  • Fax: 480-718-7859
Mailing address:
  • Phone: 480-452-4797
  • Fax: 480-264-2763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3828
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: