Provider Demographics
NPI:1336673714
Name:KANGOMBE, JANISE LYDIA (LMSW)
Entity Type:Individual
Prefix:
First Name:JANISE
Middle Name:LYDIA
Last Name:KANGOMBE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JANISE
Other - Middle Name:L
Other - Last Name:GERMOSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:120 BEACH 26TH ST APT 613
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2237
Mailing Address - Country:US
Mailing Address - Phone:347-576-8201
Mailing Address - Fax:
Practice Address - Street 1:11416 103RD AVE
Practice Address - Street 2:APT2
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1828
Practice Address - Country:US
Practice Address - Phone:646-657-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0970891104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker