Provider Demographics
NPI:1821246943
Name:KANAZI, RANIA LEE K
Entity Type:Individual
Prefix:
First Name:RANIA LEE
Middle Name:K
Last Name:KANAZI
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 1:24 E 12TH ST RM 605
Mailing Address - Street 2:FLOOR 6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4552
Mailing Address - Country:US
Mailing Address - Phone:917-496-6806
Mailing Address - Fax:
Practice Address - Street 1:24 E 12TH ST RM 605
Practice Address - Street 2:FLOOR 6
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4552
Practice Address - Country:US
Practice Address - Phone:917-496-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074308-1101YM0800X
NY730773561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331945Medicare PIN