Healthcare Provider Details

I. General information

NPI: 1093343394
Provider Name (Legal Business Name): SHAINA LEAH TENENBAUM BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 COMMERCE BLVD
DICKSON CITY PA
18519-1759
US

IV. Provider business mailing address

530 CLAY AVE APT 103
SCRANTON PA
18510-2141
US

V. Phone/Fax

Practice location:
  • Phone: 570-489-5561
  • Fax:
Mailing address:
  • Phone: 216-224-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: