Provider Demographics
NPI:1558450502
Name:LANE, PATRICIA ANNE (CASAC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:LANE
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5700 W GENESEE ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-3200
Mailing Address - Country:US
Mailing Address - Phone:315-488-1641
Mailing Address - Fax:315-488-1655
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:SUITE 118
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-488-1641
Practice Address - Fax:315-488-1655
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CASAC5711101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)