Provider Demographics
NPI:1942068994
Name:LANE, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E AVENUE I STE 107
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1941
Mailing Address - Country:US
Mailing Address - Phone:213-361-7882
Mailing Address - Fax:
Practice Address - Street 1:340 E AVENUE I STE 107
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-1941
Practice Address - Country:US
Practice Address - Phone:213-361-7882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker