Provider Demographics
NPI:1144414897
Name:LANE-SMITH, ROSA LAVONNE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:LAVONNE
Last Name:LANE-SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14034 HOLLYPARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3010
Mailing Address - Country:US
Mailing Address - Phone:832-641-1311
Mailing Address - Fax:
Practice Address - Street 1:14034 HOLLYPARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3010
Practice Address - Country:US
Practice Address - Phone:832-641-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14718171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator