Healthcare Provider Details

I. General information

NPI: 1285142851
Provider Name (Legal Business Name): LANAYA WADE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W 83RD ST UNIT 803
NEW YORK NY
10024-0831
US

IV. Provider business mailing address

127 W 83RD ST UNIT 803
NEW YORK NY
10024-0831
US

V. Phone/Fax

Practice location:
  • Phone: 332-203-3530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number025599-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: