Provider Demographics
NPI:1780122093
Name:LANE, JANET ELIZABETH (MFT)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:ELIZABETH
Last Name:LANE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 TAMAL VISTA BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1157
Mailing Address - Country:US
Mailing Address - Phone:415-413-3972
Mailing Address - Fax:
Practice Address - Street 1:240 TAMAL VISTA BLVD STE 260
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1157
Practice Address - Country:US
Practice Address - Phone:415-413-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2983101YP2500X
CA106904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional