Provider Demographics
NPI:1972539377
Name:SCHANZER, LAKSHYAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAKSHYAN
Middle Name:
Last Name:SCHANZER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SHIRLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3326
Mailing Address - Country:US
Mailing Address - Phone:401-369-8115
Mailing Address - Fax:
Practice Address - Street 1:60 SHIRLEY BLVD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3326
Practice Address - Country:US
Practice Address - Phone:401-369-8115
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00490103TC0700X
MA6385103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI61-99718OtherUNITED HEALTH ID
RI410236OtherBLUE CHIP
RI3346-4OtherBCBSRI