Provider Demographics
NPI:1437247079
Name:MURRAY-LANE, MARIE BARBARA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:BARBARA
Last Name:MURRAY-LANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 MAIN STREET EXTENSION
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-526-4234
Mailing Address - Fax:860-526-4234
Practice Address - Street 1:282 MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4467
Practice Address - Country:US
Practice Address - Phone:860-526-4234
Practice Address - Fax:860-526-4234
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0039511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical