MR. JACK S. TANENBAUM LCSW
NPI 1154419505
Counselor - Mental Health in Lodi, CA
About Mr. Jack S. Tanenbaum Lcsw NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. JACK S. TANENBAUM LCSW (NPI 1154419505) is an individual mental health provider in Lodi, California, licensed in California (LCS 1098) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS and is a graduate of New York University School Of Medicine (1964).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Mr. Jack S. Tanenbaum Lcsw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Other Providers at the Same Location NPPES 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LODI, CA 95242
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jack Tanenbaum's NPI number?
The NPI number for Jack Tanenbaum is 1154419505. It was assigned to this individual provider in the NPPES registry on October 11, 2006.
Where is Jack Tanenbaum located?
Jack Tanenbaum practices at 1920 Tienda Dr Ste 101, Lodi, CA 95242. The listed phone number is (916) 662-5947.
What is Jack Tanenbaum's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Jack Tanenbaum enrolled in Medicare?
Yes. Jack Tanenbaum is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
What insurance does Jack Tanenbaum accept?
Health plans from Providence Health Plan list Jack Tanenbaum as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Jack Tanenbaum was last updated on October 1, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mr. Jack S. Tanenbaum, LCSW · NPI 1154419505
Mental Health provider in Lodi, California. Individual provider, active in the CMS NPPES registry since October 11, 2006.
## Identity
- **NPI:** 1154419505 (Entity type: Individual)
- **Enumerated:** October 11, 2006
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **State license:** LCS 1098 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1920 TIENDA DR, STE 101, Lodi, CA 95242-3930
- **Phone:** (916) 662-5947 · **Fax:** (209) 366-1133
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Medical school:** New York University School Of Medicine, class of 1964
## Record status
- **NPPES last updated:** October 1, 2010
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Source: [NPI Profile](https://npiprofile.com/npi/1154419505) · Data from the CMS NPPES public registry.