Jack Tanenbaum, LCSW

NPI 1154419505 · on the registry since 2006 · sole proprietor

Practice

Address: 1920 Tienda Dr
Ste 101
Lodi, CA 95242
Phone: (916) 662-5947
Fax: (209) 366-1133
Organisation at this address: Ronda Shoemaker Lcsw
Lodi Children'S Clinic Medical Corporation
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 5

Registry record

Primary taxonomy: 101YM0800X
101YM0800X
Licence states on file: CA
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2010-10-01

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California