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General NPI Number Information
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NPI Number | 1881734630
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Entity Type | Individual
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Provider Name | BRENDA PEARL TENNER MSW
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 61 JANE ST
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City | NEW YORK
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State | NY
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Zip | 10014-5107
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Country | US
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Telephone | 516-466-4246
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Fax | 516-295-3195
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Provider Business Mailing Address
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Address Line | 61 JANE STREET
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City | NEW YORK
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State | NY
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Zip | 10014
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Country | US
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Telephone | 917-453-6861
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Fax | 516-295-9165
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | PRO 21845 1
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License Number State | NY
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