Provider Demographics
NPI:1376633305
Name:MICHAELS, LANA MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:MARIE
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:M
Other - Last Name:MICHAELS CONNORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW CSWR
Mailing Address - Street 1:142 BIDWELL PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222
Mailing Address - Country:US
Mailing Address - Phone:716-870-5563
Mailing Address - Fax:716-886-0016
Practice Address - Street 1:142 BIDWELL PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222
Practice Address - Country:US
Practice Address - Phone:716-886-7142
Practice Address - Fax:716-886-0016
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR014493104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
00053446001OtherUNIVERA
174486OtherCOMPSYCH
7491997OtherVALUE OPTIONS GHI
NY000500722001OtherBCBS
00053446001OtherUNIVERA