Provider Demographics
NPI:1194161430
Name:LANNIGAN, WILLIAM J (LMHC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:LANNIGAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1859
Mailing Address - Country:US
Mailing Address - Phone:862-242-6737
Mailing Address - Fax:
Practice Address - Street 1:3974 AMBOY RD
Practice Address - Street 2:SUITE 306
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2448
Practice Address - Country:US
Practice Address - Phone:862-242-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000695-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health