Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Jack S. Tanenbaum, LCSW

Individual provider Mental Health Counselor · NPI 1154419505

Mr. Jack S. Tanenbaum, LCSW is a Clinical Social Worker in Lodi, California. Graduated from New York University School of Medicine in 1964, 62 years ago. Practices as a sole proprietor, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
62
Trained at
New York University School of Medicine
Licensed in
CA
In the registry since
2006
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

1920 Tienda Dr Ste 101
Lodi, CA 95242-3930
Phone: (916) 662-5947
Fax: (209) 366-1133
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence LCS 1098 (CA)

Record details

NPI number1154419505
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedOctober 11, 2006
Last updated in NPPESOctober 1, 2010

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolNEW YORK UNIVERSITY SCHOOL OF MEDICINE
Graduated 1964 (62 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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