Healthcare Provider Details

I. General information

NPI: 1164575999
Provider Name (Legal Business Name): DAVID J TENNENBAUM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 REED RD STE 211A
COLUMBUS OH
43220-2594
US

IV. Provider business mailing address

5151 REED RD STE 211A
COLUMBUS OH
43220-2594
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-6517
  • Fax: 614-451-5387
Mailing address:
  • Phone: 614-451-6517
  • Fax: 614-451-5387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number2080
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: