| Doctor Name: | DR. ILANA TANNENBAUM |
| NPI Number: | 1003131269 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 35SI00470500 |
| Business Practice Address: | 31 S Fullerton Ave 2nd Floor Montclair, NJ - 070423455 |
| Business Phone Number: | 9737444494 |
| Business Fax Number: | |
| Mailing Address: | 296 Berkeley Ave, BLOOMFIELD |
| State: | NJ |
| Postal Code: | 070034946 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/31/2010 |
| NPI Last Update Date: | 03/31/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | 35SI00470500 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |