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NPI Code Detail

MEDICARE: MS. DEBORAH L TANNENBAUM MSW, LCSW

MEDICARE: MS. DEBORAH L TANNENBAUM MSW, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker004936MO

General Provider Information

NPI Number : 1124328604
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DEBORAH L TANNENBAUM MSW, LCSW
Provider Business Mailing Address
First Line : 3000 ARROW ROCK DR
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-6502
Country : US
Telephone Number : 314-303-2762
Fax Number :
Provider Business Practice Location Address
First Line : 4625 LINDELL BLVD FL 2
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63108-3739
Country : US
Telephone Number : 636-486-6356
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2010
Last Update Date : 09/30/2020

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