Provider Demographics
NPI:1104603240
Name:LANAGRINEVLCSWRPSYCHOTHERAPYPLLC
Entity type:Organization
Organization Name:LANAGRINEVLCSWRPSYCHOTHERAPYPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINEV
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:347-666-7225
Mailing Address - Street 1:2743 MILL AVE PH
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6421
Mailing Address - Country:US
Mailing Address - Phone:347-666-7225
Mailing Address - Fax:
Practice Address - Street 1:2743 MILL AVE PH
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6421
Practice Address - Country:US
Practice Address - Phone:347-666-7225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)