Provider Demographics
NPI:1629289988
Name:LANES, DENISE (LP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:LANES
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 67TH AVE
Mailing Address - Street 2:12M
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4969
Mailing Address - Country:US
Mailing Address - Phone:718-896-9560
Mailing Address - Fax:718-275-7819
Practice Address - Street 1:26 W 9TH ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8971
Practice Address - Country:US
Practice Address - Phone:212-475-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000422102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst