Provider Demographics
NPI:1386926137
Name:THEUS, LANDRINA
Entity type:Individual
Prefix:
First Name:LANDRINA
Middle Name:
Last Name:THEUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 NASSAU RD
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-2016
Mailing Address - Country:US
Mailing Address - Phone:516-623-1644
Mailing Address - Fax:516-623-3125
Practice Address - Street 1:175 NASSAU RD
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-2016
Practice Address - Country:US
Practice Address - Phone:516-623-1644
Practice Address - Fax:516-623-3125
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool