Provider Demographics
NPI:1467669929
Name:TANZER, WAYNE GEORGE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:GEORGE
Last Name:TANZER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8013 NEW LAGRANGE RD.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4700
Mailing Address - Country:US
Mailing Address - Phone:502-551-0526
Mailing Address - Fax:502-429-6562
Practice Address - Street 1:8013 NEW LAGRANGE RD.
Practice Address - Street 2:SUITE 1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4700
Practice Address - Country:US
Practice Address - Phone:502-551-0526
Practice Address - Fax:502-429-6562
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical