Basic Information
Provider Information
NPI: 1841687431
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LANIER
FirstName: DONALD
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6 GRAMATAN AVE
Address2: SUITE 401 - C/O WJCS
City: MOUNT VERNON
State: NY
PostalCode: 105503208
CountryCode: US
TelephoneNumber: 9146688938
FaxNumber: 9146682545
Practice Location
Address1: 6 GRAMATAN AVE
Address2: SUITE 401 - C/O WJCS
City: MOUNT VERNON
State: NY
PostalCode: 105503208
CountryCode: US
TelephoneNumber: 9146688938
FaxNumber: 9146682545
Other Information
ProviderEnumerationDate: 04/21/2015
LastUpdateDate: 04/21/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X094536NYY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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