Provider Demographics
NPI:1497366686
Name:LANE, LIAM R
Entity Type:Individual
Prefix:
First Name:LIAM
Middle Name:R
Last Name:LANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-6009
Mailing Address - Country:US
Mailing Address - Phone:508-679-5222
Mailing Address - Fax:508-673-3182
Practice Address - Street 1:386 STANLEY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-6009
Practice Address - Country:US
Practice Address - Phone:508-679-5222
Practice Address - Fax:508-673-3182
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14701101YA0400X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)