Provider Demographics
NPI:1538129838
Name:LANE, JOHN P (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:LANE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32016 TEAL CT
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-7206
Mailing Address - Country:US
Mailing Address - Phone:909-435-7863
Mailing Address - Fax:
Practice Address - Street 1:1150 BROOKSIDE AVE
Practice Address - Street 2:STE J3
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6303
Practice Address - Country:US
Practice Address - Phone:909-435-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS190881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical