Healthcare Provider Details

I. General information

NPI: 1043644669
Provider Name (Legal Business Name): SHANNA TIFFANY BEAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNA TIFFANY GERMAN PSY.D.

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 CENTRAL PARK WEST SUITE 1 D
NEW YORK NY
10023
US

IV. Provider business mailing address

146 CENTRAL PARK WEST SUITE 1 D
NEW YORK NY
10023
US

V. Phone/Fax

Practice location:
  • Phone: 917-740-4280
  • Fax: 212-459-1520
Mailing address:
  • Phone: 917-740-4280
  • Fax: 212-459-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number020918
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: