Provider Demographics
NPI:1326085283
Name:TANENBAUM, ISABEL (LMHC, CAP)
Entity Type:Individual
Prefix:MS
First Name:ISABEL
Middle Name:
Last Name:TANENBAUM
Suffix:
Gender:F
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 HALCYON LN
Mailing Address - Street 2:SUITE 701
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6689
Mailing Address - Country:US
Mailing Address - Phone:904-292-2407
Mailing Address - Fax:904-292-2409
Practice Address - Street 1:2950 HALCYON LN
Practice Address - Street 2:SUITE 701
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6692
Practice Address - Country:US
Practice Address - Phone:904-292-2407
Practice Address - Fax:904-292-2409
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP2184101YA0400X
FLMH5265101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
460840OtherVALUE OPTIONS
7825255OtherAETNA PROVIDER
2081858OtherCIGNA
Z9784OtherBLUE CROSS BLUE SHIELD