Provider Demographics
NPI:1154479897
Name:LANHAM, JANET SIMONSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:SIMONSON
Last Name:LANHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 RAWSON RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-2040
Mailing Address - Country:US
Mailing Address - Phone:617-773-5166
Mailing Address - Fax:
Practice Address - Street 1:23 E ELM AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-2905
Practice Address - Country:US
Practice Address - Phone:617-745-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0067OtherBLUECROSS BLUE SHIELD
MAXXXXX3838OtherUNITED BEHAVIORAL HEALTH