Provider Demographics
NPI:1841915717
Name:LU, LENA (LCSW-R)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 WOODSIDE AVE APT 507
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3682
Mailing Address - Country:US
Mailing Address - Phone:646-522-0646
Mailing Address - Fax:
Practice Address - Street 1:6210 WOODSIDE AVE APT 507
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3682
Practice Address - Country:US
Practice Address - Phone:646-522-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0212571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical