Provider Demographics
NPI:1417254608
Name:TANNEN, CAROL HERMAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:HERMAN
Last Name:TANNEN
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 1:4489 WOODFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5317
Mailing Address - Country:US
Mailing Address - Phone:561-241-4622
Mailing Address - Fax:561-241-4274
Practice Address - Street 1:4489 WOODFIELD BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-5317
Practice Address - Country:US
Practice Address - Phone:561-289-9681
Practice Address - Fax:561-241-4274
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW101941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical