Provider Demographics
NPI:1770398190
Name:TANTAY, LAWRENCE JUDE (LLMSW)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JUDE
Last Name:TANTAY
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1602
Mailing Address - Country:US
Mailing Address - Phone:732-266-3048
Mailing Address - Fax:
Practice Address - Street 1:826 LEROY ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1602
Practice Address - Country:US
Practice Address - Phone:732-266-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511193831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical