Provider Demographics
NPI:1609036581
Name:LANE-GARLAND, KAREN DIANE (M A)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:DIANE
Last Name:LANE-GARLAND
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301A W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 304-B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3409
Mailing Address - Country:US
Mailing Address - Phone:561-213-0120
Mailing Address - Fax:561-483-5890
Practice Address - Street 1:11352 CHISOLM WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1128
Practice Address - Country:US
Practice Address - Phone:561-213-0120
Practice Address - Fax:561-483-5890
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS0000729103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ148UOtherBLUECROSS AND BLUESHIELD OF FLORIDA