Provider Demographics
NPI:1386784122
Name:PERRY- MOORE, LANETTA JEAN
Entity type:Individual
Prefix:MRS
First Name:LANETTA
Middle Name:JEAN
Last Name:PERRY- MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LANETTA
Other - Middle Name:JEAN
Other - Last Name:PERRY- MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWR, CASAC
Mailing Address - Street 1:187 PINEHURST AVE
Mailing Address - Street 2:1G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-1847
Mailing Address - Country:US
Mailing Address - Phone:212-281-5695
Mailing Address - Fax:212-281-5892
Practice Address - Street 1:187 PINEHURST AVE
Practice Address - Street 2:1G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-1847
Practice Address - Country:US
Practice Address - Phone:212-281-5695
Practice Address - Fax:212-281-5892
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0754991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical