Provider Demographics
NPI:1033698469
Name:LANE, CAROL M (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:LANE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 LINNAEAN ST APT 45
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1571
Mailing Address - Country:US
Mailing Address - Phone:617-868-6866
Mailing Address - Fax:
Practice Address - Street 1:41 LINNAEAN ST APT 45
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1571
Practice Address - Country:US
Practice Address - Phone:617-868-6866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103525-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical