Provider Demographics
NPI:1831202530
Name:LANE, LOIS (LCSW)
Entity type:Individual
Prefix:MS
First Name:LOIS
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 RED HILL AVE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2450
Mailing Address - Country:US
Mailing Address - Phone:415-459-3342
Mailing Address - Fax:
Practice Address - Street 1:412 RED HILL AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2450
Practice Address - Country:US
Practice Address - Phone:415-459-3342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS39631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ35583ZMedicare ID - Type Unspecified