Healthcare Provider Details

I. General information

NPI: 1649534892
Provider Name (Legal Business Name): SUSAN LANKENAU LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 RICH ST
BUFFALO NY
14211-3020
US

IV. Provider business mailing address

741 DELAWARE AVE
BUFFALO NY
14209-2201
US

V. Phone/Fax

Practice location:
  • Phone: 716-895-7715
  • Fax:
Mailing address:
  • Phone: 716-218-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number00083517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: