Provider Demographics
NPI:1992721823
Name:LANDER, HARRIET S (PH D)
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:S
Last Name:LANDER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S MERAMEC AVE
Mailing Address - Street 2:SUITE 432T
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3597
Mailing Address - Country:US
Mailing Address - Phone:314-388-5255
Mailing Address - Fax:314-721-6388
Practice Address - Street 1:225 S MERAMEC AVE
Practice Address - Street 2:SUITE 432T
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3597
Practice Address - Country:US
Practice Address - Phone:314-388-5255
Practice Address - Fax:314-721-6388
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01106103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO8408OtherBLUE CROSS BLUE SHIELD