Provider Demographics
NPI:1457003956
Name:LANE, KACEY (PSYD)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EQUESTRIAN WAY
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1673
Mailing Address - Country:US
Mailing Address - Phone:207-712-9128
Mailing Address - Fax:
Practice Address - Street 1:14 MAINE ST STE 309
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2033
Practice Address - Country:US
Practice Address - Phone:207-607-4022
Practice Address - Fax:207-607-4048
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1447103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical