Provider Demographics
NPI:1457445934
Name:LANE, DANIEL JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:LANE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PENI PL
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8772
Mailing Address - Country:US
Mailing Address - Phone:808-878-3348
Mailing Address - Fax:
Practice Address - Street 1:1135 MAKAWAO AVE
Practice Address - Street 2:SUITE #204
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-7403
Practice Address - Country:US
Practice Address - Phone:808-280-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY - 933103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000258475OtherHMSA
HI57950001Medicaid
HI57950001Medicaid