Provider Demographics
NPI:1578795571
Name:LANE, JACQUELINE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W. LITTLETON BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2352
Mailing Address - Country:US
Mailing Address - Phone:720-251-5628
Mailing Address - Fax:844-203-9934
Practice Address - Street 1:609 W LITTLETON BLVD STE 309
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2352
Practice Address - Country:US
Practice Address - Phone:720-251-5628
Practice Address - Fax:844-203-9934
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW09923164OtherCLINICAL SOCIAL WORKER