Provider Demographics
NPI:1942395850
Name:LANESE, MICHELE LINDA (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LINDA
Last Name:LANESE
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 1:4855 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4356
Mailing Address - Country:US
Mailing Address - Phone:954-345-5525
Mailing Address - Fax:954-977-4978
Practice Address - Street 1:4855 W HILLSBORO BLVD
Practice Address - Street 2:SUITE B1
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4356
Practice Address - Country:US
Practice Address - Phone:954-345-5525
Practice Address - Fax:954-977-4978
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0001662104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2192OtherBCBS FLA
FLZ2192OtherBCBS FLA