Jack S. Tanenbaum is a Mental Health in Lodi, California. Jack S. Tanenbaum practices all healthcare services and medical treatments related to Mental Health. The NPI Number for Jack S. Tanenbaum is 1154419505. The last update date is 2010-10-01.
Jack S. Tanenbaum's current location address is 2715 W Kettleman Ln, Lodi, California. You can contact this provider via phone number 9166625947 and fax number 2093661133. The mailing address for Jack S. Tanenbaum is 2715 W Kettleman Ln, Lodi, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jack S. Tanenbaum |
|---|---|
| Address | 2715 W Kettleman Ln, Lodi, California |
| Phone Number | 9166625947 |
| Fax Number | 2093661133 |
| Sole Proprietor | Y |
| Credentials | LCSW |
NPI Number Detail
| NPI Number | 1154419505 |
|---|---|
| Provider Enumeration Date | 2006-10-11 |
| Last Updated Date | 2010-10-01 |
Provider Mailing Address Detail
| Address | 2715 W Kettleman Ln |
|---|---|
| City | Lodi |
| State | California (CA) |
| Post Code | 952429289 |
| Phone Number | 9166625947 |
| Fax Number | 2093661133 |
Provider's Primary Taxonomy Detail
| Speciality | Mental Health |
|---|---|
| Taxonomy | 101Ym0800X |
| Licence No | LCS 1098 |
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Definition: A counselor who helps people manage conditions like depression, anxiety, grief, relationship issues, and more. |
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What is the unique 10-digit identifier code issued to Jack S. Tanenbaum by the Centers for Medicare & Medicaid Services?
The Jack S. Tanenbaum has been assigned the NPI (National Provider Identifier) 1154419505 by the CMS (Centers for Medicare & Medicaid Services). This 10-digit code serves as a unique identification number for healthcare providers.
Can you provide the Jack S. Tanenbaum's physical address?
The Jack S. Tanenbaum is physically located at 2715 W Kettleman Ln, in the city of Lodi, CA, with the postal code 952429289.
What is Jack S. Tanenbaum's specialized field of practice, and what is the corresponding taxonomy code that categorizes this area of expertise?
The area of specialization for Jack S. Tanenbaum is Mental Health, and the taxonomy code that classifies this field of practice is 101Ym0800X.
On what date was the 1154419505 assigned to Jack S. Tanenbaum?
The Jack S. Tanenbaum was issued its 1154419505 on 2006-10-11, which is the date when this unique identifier was assigned to the organization by the Centers for Medicare & Medicaid Services.
As of what date were the details pertaining to Jack S. Tanenbaum last refreshed?
The information related to the Jack S. Tanenbaum, including its address, specialty, and other relevant details, was last updated on 2010-10-01.