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Individual
MR. KEITH JOHN TANENBAUM
Active
Individual
MR. KEITH JOHN TANENBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
89589
CA
1041C0700X
Clinical Social Worker
Primary
107974
CA
2084H0002X
Hospice and Palliative Medicine (Psychiatry & Neurology) Physician
107074
CA
Other
Enumeration date
09/22/2020
Last updated
10/05/2022
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