Provider Demographics
NPI:1881978328
Name:LANE, CELESTE KATHLEEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:KATHLEEN
Last Name:LANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CELESTE
Other - Middle Name:KATHLEEN
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW/ASW
Mailing Address - Street 1:790 E BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1906
Mailing Address - Country:US
Mailing Address - Phone:909-625-7207
Mailing Address - Fax:
Practice Address - Street 1:790 E BONITA AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1906
Practice Address - Country:US
Practice Address - Phone:909-625-7207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW685081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical