MEDICARE: MS. JASMINE LANE LCSW

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
1	1041C0700X	Clinical Social Worker	LC10013	ME
2	1041C0700X	Clinical Social Worker	SW12433	FL

General Provider Information

NPI Number	:	1912177312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JASMINE LANE LCSW

Provider Business Mailing Address
First Line	:	620 W SHADY LN
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-2052
Country	:	US
Telephone Number	:	863-968-6348
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 E EDGEWOOD DR STE 4
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-3660
Country	:	US
Telephone Number	:	863-968-6348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	02/28/2025

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