Provider Demographics
NPI:1174711659
Name:LANZA, FEDERICA (LCSW)
Entity type:Individual
Prefix:
First Name:FEDERICA
Middle Name:
Last Name:LANZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 E IRON EAGLE DR STE 130D
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6599
Mailing Address - Country:US
Mailing Address - Phone:208-684-2585
Mailing Address - Fax:208-547-6835
Practice Address - Street 1:1243 E IRON EAGLE DR STE 130D
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6599
Practice Address - Country:US
Practice Address - Phone:208-684-2585
Practice Address - Fax:208-547-6835
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-336571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical