Healthcare Provider Details

I. General information

NPI: 1992849301
Provider Name (Legal Business Name): TANANBAUM & ZIBBELL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FRANKLIN COMMONS
FRAMINGHAM MA
01702-6619
US

IV. Provider business mailing address

1 FRANKLIN COMMONS
FRAMINGHAM MA
01702-6619
US

V. Phone/Fax

Practice location:
  • Phone: 508-872-6610
  • Fax: 508-872-6722
Mailing address:
  • Phone: 508-872-6610
  • Fax: 508-872-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3783
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103194
License Number StateMA

VIII. Authorized Official

Name: DR. RONA L. TANABAUM
Title or Position: PRESIDENT
Credential: PH. D.
Phone: 508-872-6610