Provider Demographics
NPI:1275632150
Name:ACKAWAY, LANA M (NYS LICENSED CLINICA)
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:M
Last Name:ACKAWAY
Suffix:
Gender:F
Credentials:NYS LICENSED CLINICA
Other - Prefix:MS
Other - First Name:LANA
Other - Middle Name:M
Other - Last Name:ACKAWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED PSYCHOANAL
Mailing Address - Street 1:241 EAST 38TH ST.
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2787
Mailing Address - Country:US
Mailing Address - Phone:917-294-7883
Mailing Address - Fax:212-953-6902
Practice Address - Street 1:280 MADISON AVE
Practice Address - Street 2:SUITE 608
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10016-2787
Practice Address - Country:US
Practice Address - Phone:917-294-7883
Practice Address - Fax:212-953-6902
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02914711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical