Provider Demographics
NPI:1558848366
Name:LETANG, LANISA
Entity type:Individual
Prefix:MS
First Name:LANISA
Middle Name:
Last Name:LETANG
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 1:124 MIDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5108
Mailing Address - Country:US
Mailing Address - Phone:631-704-4685
Mailing Address - Fax:
Practice Address - Street 1:124 MIDWOOD ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5108
Practice Address - Country:US
Practice Address - Phone:631-704-4685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst