Provider Demographics
NPI:1083871537
Name:TANZER, LARAINE ALISON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LARAINE
Middle Name:ALISON
Last Name:TANZER
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 1:408 WESTMINSTER AVENUE
Mailing Address - Street 2:#10
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-903-1823
Mailing Address - Fax:949-720-9808
Practice Address - Street 1:408 WESTMINSTER AVENUE
Practice Address - Street 2:#10
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-903-1823
Practice Address - Fax:949-720-9808
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS230071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical