Provider Demographics
NPI:1679269146
Name:LANEAUD, MARIE CHANTAL MASCARY
Entity Type:Individual
Prefix:
First Name:MARIE CHANTAL
Middle Name:MASCARY
Last Name:LANEAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1314
Mailing Address - Country:US
Mailing Address - Phone:516-523-2616
Mailing Address - Fax:
Practice Address - Street 1:1056 NORTH DR
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1314
Practice Address - Country:US
Practice Address - Phone:516-523-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty