Provider Demographics
NPI:1326248451
Name:LANDERS, THOMAS AQUINAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:AQUINAS
Last Name:LANDERS
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 1:119 N PARK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4113
Mailing Address - Country:US
Mailing Address - Phone:516-637-1714
Mailing Address - Fax:
Practice Address - Street 1:119 N PARK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4113
Practice Address - Country:US
Practice Address - Phone:516-637-1714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0753421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical