Provider Demographics
NPI:1255600938
Name:LANE, JANINE K (BCBA)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:K
Last Name:LANE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 RIVER ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-6564
Mailing Address - Country:US
Mailing Address - Phone:508-688-4695
Mailing Address - Fax:
Practice Address - Street 1:211 RIVER ST
Practice Address - Street 2:UNIT 1
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-6564
Practice Address - Country:US
Practice Address - Phone:508-688-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-24
Last Update Date:2011-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-10-7044103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst