Provider Demographics
NPI:1073386835
Name:LANZA, ANN MARIE
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:LANZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 LAMBERTS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7211
Mailing Address - Country:US
Mailing Address - Phone:917-972-9214
Mailing Address - Fax:
Practice Address - Street 1:1854 HYLAN BLVD STE 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2119
Practice Address - Country:US
Practice Address - Phone:917-553-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst