Provider Demographics
NPI:1578677225
Name:LANE, ERIC J (PSYD, PA)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:LANE
Suffix:
Gender:M
Credentials:PSYD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1104 KENILWORTH DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2101
Mailing Address - Country:US
Mailing Address - Phone:443-280-2916
Mailing Address - Fax:410-377-4844
Practice Address - Street 1:1104 KENILWORTH DR
Practice Address - Street 2:SUITE 302
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2101
Practice Address - Country:US
Practice Address - Phone:443-280-2916
Practice Address - Fax:410-377-4844
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD04531103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical