Healthcare Provider Details

I. General information

NPI: 1063200962
Provider Name (Legal Business Name): LAKEVIEW THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CAUSEWAY ST APT 910
BOSTON MA
02114-1649
US

IV. Provider business mailing address

50 CAUSEWAY ST APT 910
BOSTON MA
02114-1649
US

V. Phone/Fax

Practice location:
  • Phone: 203-645-2948
  • Fax:
Mailing address:
  • Phone: 203-645-2948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JANE ELIZABETH MARCHAND
Title or Position: CLINICIAN
Credential: LICSW
Phone: 203-645-2948