Provider Demographics
NPI:1427337245
Name:TANNENBAUM, KACEE ELAINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KACEE
Middle Name:ELAINE
Last Name:TANNENBAUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NE 30TH PL
Mailing Address - Street 2:SUITE # 408
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1928
Mailing Address - Country:US
Mailing Address - Phone:954-800-0108
Mailing Address - Fax:
Practice Address - Street 1:3000 NE 30TH PL
Practice Address - Street 2:SUITE # 408
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1928
Practice Address - Country:US
Practice Address - Phone:954-800-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 98791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical