Individual provider · Type 1 NPI

Jack S. Tanenbaum, LCSW

Mental Health Counselor · Lodi, CA

NPI number 1154419505 Active

Practice location

1920 Tienda Dr, Ste 101
Lodi, CA 95242-3930

Call (916) 662-5947 Map

Fax (209) 366-1133

Mailing address

2715 W Kettleman Ln, Ste 203-113
Lodi, CA 95242-9289

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XLCS 1098 (CA)

Mental Health Counselor: Definition to come...

3 other providers at this address

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About NPI 1154419505

Jack S. Tanenbaum, LCSW's National Provider Identifier is 1154419505, issued on Oct 11, 2006. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Lodi, CA. The record was last updated on Oct 1, 2010.