Provider Demographics
NPI:1891044830
Name:PROVERBS, TANISHA
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:PROVERBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-3302
Mailing Address - Country:US
Mailing Address - Phone:973-953-8632
Mailing Address - Fax:
Practice Address - Street 1:566 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1802
Practice Address - Country:US
Practice Address - Phone:212-564-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2025-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010358-01101YM0800X
101YM0800X
NJ37PC01024700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health