Healthcare Provider Details

I. General information

NPI: 1114251436
Provider Name (Legal Business Name): ALLISON TARA LANSKY MA, ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 WITHERSPOON ST
PRINCETON NJ
08540-3211
US

IV. Provider business mailing address

253 WITHERSPOON ST
PRINCETON NJ
08540-3211
US

V. Phone/Fax

Practice location:
  • Phone: 609-497-4000
  • Fax: 609-497-4412
Mailing address:
  • Phone: 609-497-4000
  • Fax: 609-497-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00058300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: