Provider Demographics
NPI:1740695626
Name:LA ROSE, LANNA I
Entity type:Individual
Prefix:MS
First Name:LANNA
Middle Name:
Last Name:LA ROSE
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LANNA
Other - Middle Name:NICOLE
Other - Last Name:LA ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASTERS
Mailing Address - Street 1:123 SOMERS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-2909
Mailing Address - Country:US
Mailing Address - Phone:347-495-0022
Mailing Address - Fax:
Practice Address - Street 1:123 SOMER STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11233
Practice Address - Country:US
Practice Address - Phone:347-495-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY844261141103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst