Provider Demographics
NPI:1275609604
Name:HAUBEN, LANA (LICSW)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:HAUBEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 ELM ST
Mailing Address - Street 2:P.O. BOX 143
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-9642
Mailing Address - Country:US
Mailing Address - Phone:802-362-5590
Mailing Address - Fax:802-362-5192
Practice Address - Street 1:56 ELM ST
Practice Address - Street 2:STREET LEVEL
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9642
Practice Address - Country:US
Practice Address - Phone:802-362-5590
Practice Address - Fax:802-362-5192
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900008831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical