Provider Demographics
NPI:1740354554
Name:LANCASTER, MARY ANN (APRN BC)
Entity type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 KEARNY AVENUE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3005
Mailing Address - Country:US
Mailing Address - Phone:201-997-7303
Mailing Address - Fax:
Practice Address - Street 1:500 NORTH BRIDGE STREET
Practice Address - Street 2:RICHARD HALL COMMUNITY MENTAL HEALTH CENTER
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807
Practice Address - Country:US
Practice Address - Phone:908-253-3166
Practice Address - Fax:908-704-1790
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO04712900364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
881364CIEMedicare ID - Type Unspecified