Provider Demographics
NPI:1366613648
Name:NYANZA, LORRAINA (MSW LISW MAC)
Entity type:Individual
Prefix:MRS
First Name:LORRAINA
Middle Name:
Last Name:NYANZA
Suffix:
Gender:F
Credentials:MSW LISW MAC
Other - Prefix:
Other - First Name:LORRAINA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CMR 431 BOX 2456
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09175
Mailing Address - Country:DE
Mailing Address - Phone:01149615-169-1710
Mailing Address - Fax:01149615-169-7579
Practice Address - Street 1:CAMBRAI FRITSCH KASEM BLDG 4006 RM 305
Practice Address - Street 2:ARMY SUBSTANCE ABUSE PROGRAM
Practice Address - City:DARMSTADT
Practice Address - State:AE
Practice Address - Zip Code:APO
Practice Address - Country:DE
Practice Address - Phone:01149615-169-1710
Practice Address - Fax:01149615-169-7579
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLISWI05762104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker