Healthcare Provider Details

I. General information

NPI: 1851431019
Provider Name (Legal Business Name): PATRICK LANTZY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VALLEY RD SUITE 301
MT ARLINGTON NJ
07856-1320
US

IV. Provider business mailing address

PO BOX 26
CHESTER NJ
07930-0026
US

V. Phone/Fax

Practice location:
  • Phone: 973-601-0100
  • Fax: 973-338-2211
Mailing address:
  • Phone: 973-601-0100
  • Fax: 973-338-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPA PS-005396-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberSI 03721
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: