Provider Demographics
NPI:1356468060
Name:LANE, VERANIA D (MS, MLRI)
Entity Type:Individual
Prefix:MRS
First Name:VERANIA
Middle Name:D
Last Name:LANE
Suffix:
Gender:F
Credentials:MS, MLRI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GOLF CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4664
Mailing Address - Country:US
Mailing Address - Phone:407-772-1556
Mailing Address - Fax:
Practice Address - Street 1:105 GOLF CLUB DR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4664
Practice Address - Country:US
Practice Address - Phone:407-782-1556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health