Provider Demographics
NPI:1912009937
Name:LANTZ, MARY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:LANTZ
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 1:408 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3532
Mailing Address - Country:US
Mailing Address - Phone:973-655-9005
Mailing Address - Fax:973-655-9006
Practice Address - Street 1:408 BLOOMFIELD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3532
Practice Address - Country:US
Practice Address - Phone:973-655-9005
Practice Address - Fax:973-655-9006
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051832001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical