Provider Demographics
NPI:1710627112
Name:LANE, MIRANDA (PSYD, LCMHC)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:PSYD, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:CANTERBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03224-0016
Mailing Address - Country:US
Mailing Address - Phone:603-702-0658
Mailing Address - Fax:
Practice Address - Street 1:12 NEW RD
Practice Address - Street 2:
Practice Address - City:CANTERBURY
Practice Address - State:NH
Practice Address - Zip Code:03224-2309
Practice Address - Country:US
Practice Address - Phone:603-702-0658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health