Provider Demographics
NPI:1346891975
Name:DELACRUZ-LANE, RAUL ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:ANTHONY
Last Name:DELACRUZ-LANE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:RAUL
Other - Middle Name:ANTHONY
Other - Last Name:DELACRUZ-LANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3625 MANSON PIKE UNIT 5105
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-4146
Mailing Address - Country:US
Mailing Address - Phone:850-860-1529
Mailing Address - Fax:
Practice Address - Street 1:1310 24TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:615-873-6938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0151101YA0400X
NMCMH0173081101YM0800X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health