Provider Demographics
NPI:1013147214
Name:LANO, JEANNIE
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:
Last Name:LANO
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 1:202 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3114
Mailing Address - Country:US
Mailing Address - Phone:321-373-2281
Mailing Address - Fax:321-373-2294
Practice Address - Street 1:202 4TH AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3114
Practice Address - Country:US
Practice Address - Phone:321-373-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health