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NPI Code Detail

MEDICARE: CHARLES J LANE

MEDICARE: CHARLES J LANE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker228640MA

General Provider Information

NPI Number : 1215743851
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES J LANE
Provider Business Mailing Address
First Line : 37 SNOW ST APT 2
Second Line :
City : BRIGHTON
State : MA
Zip : 02135-3412
Country : US
Telephone Number : 857-210-4072
Fax Number :
Provider Business Practice Location Address
First Line : 1 MEETING HOUSE RD STE 11
Second Line :
City : CHELMSFORD
State : MA
Zip : 01824-2737
Country : US
Telephone Number : 978-485-4722
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2024
Last Update Date : 01/06/2025

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Directions to “ CHARLES J LANE ” Practice Location

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