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General NPI Number Information
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NPI Number | 1194161430
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Entity Type | Individual
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Provider Name | WILLIAM J LANNIGAN LMHC
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Gender | Male
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 3974 AMBOY RD SUITE 306
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City | STATEN ISLAND
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State | NY
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Zip | 10308-2448
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Country | US
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Telephone | 862-242-6737
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Fax |
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Provider Business Mailing Address
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Address Line | 79 3RD ST
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-1859
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Country | US
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Telephone | 862-242-6737
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 000695-1
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License Number State | NY
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