Provider Demographics
NPI:1982067542
Name:LANZA, KRISTY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:
Last Name:LANZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KRISTY
Other - Middle Name:LEE
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:16 WENSLEY LN
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-3415
Mailing Address - Country:US
Mailing Address - Phone:631-834-6929
Mailing Address - Fax:
Practice Address - Street 1:16 WENSLEY LN
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-3415
Practice Address - Country:US
Practice Address - Phone:631-834-6929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0835401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical