Provider Demographics
NPI:1598972812
Name:LANDAU, IRA (PHD,LCSW-R,CASAC)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:LANDAU
Suffix:
Gender:M
Credentials:PHD,LCSW-R,CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1006
Mailing Address - Country:US
Mailing Address - Phone:516-578-2471
Mailing Address - Fax:
Practice Address - Street 1:1670-78 EAST 17TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-375-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0408061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical