Basic Information
| Provider Information | |||||||||
| NPI: | 1912319849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHERRY | ||||||||
| FirstName: | LANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 65TH ST APT 19F | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112206512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187481966 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 HOYT ST FL 7 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112015809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188020666 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2014 | ||||||||
| LastUpdateDate: | 05/27/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 071343 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.