Provider Demographics
NPI:1417318387
Name:LANE, AMY (LMSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:81 HOLLY HILL LANE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830
Mailing Address - Country:US
Mailing Address - Phone:203-321-5063
Mailing Address - Fax:
Practice Address - Street 1:81 HOLLY HILL LANE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830
Practice Address - Country:US
Practice Address - Phone:203-321-5063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061533104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker