Provider Demographics
NPI:1578712501
Name:LANDERS, ZOE AMBRE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:ZOE
Middle Name:AMBRE
Last Name:LANDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E 92ND ST
Mailing Address - Street 2:APT #5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5466
Mailing Address - Country:US
Mailing Address - Phone:646-206-6449
Mailing Address - Fax:
Practice Address - Street 1:31 WASHINGTON SQUARE PARK WEST
Practice Address - Street 2:SUITE 5R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:646-206-6449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057775104100000X
NY73-0786711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1578712501Medicaid