Healthcare Provider Details

I. General information

NPI: 1104159680
Provider Name (Legal Business Name): ANN DANIEU LANZA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MAIN ST
BUFFALO NY
14202-1102
US

IV. Provider business mailing address

332 PARKER AVE
BUFFALO NY
14216-2146
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-4706
  • Fax: 716-859-4818
Mailing address:
  • Phone: 716-479-1456
  • Fax: 716-875-7891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number077619-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: