Provider Demographics
NPI:1063011609
Name:LANZA, CAROLINE A (PHD, MSW, LSWAIC)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:A
Last Name:LANZA
Suffix:
Gender:F
Credentials:PHD, MSW, LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13035 39TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4613
Mailing Address - Country:US
Mailing Address - Phone:206-351-3182
Mailing Address - Fax:
Practice Address - Street 1:13035 39TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4613
Practice Address - Country:US
Practice Address - Phone:206-351-3182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA610889151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty