Provider Demographics
NPI:1538298161
Name:LANIER, PRESTON J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PRESTON
Middle Name:J
Last Name:LANIER
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 1:242 N JAMES ST
Mailing Address - Street 2:TOWER OFFICE PARK SUITE 204
Mailing Address - City:NEWPORT
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3182
Mailing Address - Country:US
Mailing Address - Phone:302-995-5456
Mailing Address - Fax:302-995-0292
Practice Address - Street 1:242 N JAMES ST
Practice Address - Street 2:TOWER OFFICE PARK SUITE 204
Practice Address - City:NEWPORT
Practice Address - State:DE
Practice Address - Zip Code:19804-3182
Practice Address - Country:US
Practice Address - Phone:302-995-5456
Practice Address - Fax:302-995-0292
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00007621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1041C0700XMedicaid
DE41-214372-0OtherTAX IDENTIFICATION NUMBER