Provider Demographics
NPI:1689871493
Name:LANE, STEPHANIE Z (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:Z
Last Name:LANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18780 AMAR RD STE 204
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4559
Mailing Address - Country:US
Mailing Address - Phone:626-965-4463
Mailing Address - Fax:626-965-9240
Practice Address - Street 1:18780 AMAR RD STE 204
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4559
Practice Address - Country:US
Practice Address - Phone:626-965-4463
Practice Address - Fax:626-965-9240
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALCS295211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health