Healthcare Provider Details

I. General information

NPI: 1093961450
Provider Name (Legal Business Name): DANA RENEE LEPAGE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2008
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 ROSECRANS AVE STE 300
MANHATTAN BEACH CA
90266-2494
US

IV. Provider business mailing address

45 MACKAY AVE
PARAMUS NJ
07652-1221
US

V. Phone/Fax

Practice location:
  • Phone: 310-561-1008
  • Fax:
Mailing address:
  • Phone: 585-248-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number084027-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: