Healthcare Provider Details

I. General information

NPI: 1023327079
Provider Name (Legal Business Name): JOSEPH ANTHONY LANZARA LCPC-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 AIRPORT ROAD
LINCOLN ME
04457
US

IV. Provider business mailing address

29 FRANKLIN ST
BANGOR ME
04401-4909
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-9073
  • Fax: 207-794-8919
Mailing address:
  • Phone: 207-942-3816
  • Fax: 207-561-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL3621
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC2981
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: