Provider Demographics
NPI:1407972698
Name:TAN, JENNIFER M (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:TAN
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 1:2115A LARKIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-1930
Mailing Address - Country:US
Mailing Address - Phone:404-550-7501
Mailing Address - Fax:
Practice Address - Street 1:110 GOUGH ST STE 403A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5971
Practice Address - Country:US
Practice Address - Phone:404-550-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CA271681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical