Provider Demographics
NPI:1396931358
Name:LANZA, KAREN (MA, MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:LANZA
Suffix:
Gender:F
Credentials:MA, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 KINDERKAMACK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2142
Mailing Address - Country:US
Mailing Address - Phone:201-599-1740
Mailing Address - Fax:201-465-5555
Practice Address - Street 1:370 KINDERKAMACK RD
Practice Address - Street 2:SUITE C
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-2142
Practice Address - Country:US
Practice Address - Phone:201-599-1740
Practice Address - Fax:201-465-5555
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-23
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04708000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ026073Medicare PIN