Provider Demographics
NPI:1265679237
Name:LANE, SYLVIA B (LCSW, MFT)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:B
Last Name:LANE
Suffix:
Gender:F
Credentials:LCSW, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25411 CABOT RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5520
Mailing Address - Country:US
Mailing Address - Phone:949-443-3915
Mailing Address - Fax:949-305-4577
Practice Address - Street 1:25411 CABOT RD
Practice Address - Street 2:SUITE 107
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5520
Practice Address - Country:US
Practice Address - Phone:949-443-3915
Practice Address - Fax:949-305-4577
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 13241041C0700X
CAMFT 5872106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE502AMedicare PIN