Healthcare Provider Details

I. General information

NPI: 1255351037
Provider Name (Legal Business Name): DONALD TETENBAUM PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LEDGEWOOD PL SUITE 202
ROCKLAND MA
02370-1075
US

IV. Provider business mailing address

30 HARLOW DR
AMHERST MA
01002-1410
US

V. Phone/Fax

Practice location:
  • Phone: 800-535-5526
  • Fax: 781-871-5973
Mailing address:
  • Phone: 413-549-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6029
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: