Healthcare Provider Details

I. General information

NPI: 1740184753
Provider Name (Legal Business Name): EMILY SHAW NALINI LANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NALINI LANE

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 DANFORTH ST STE 311
PORTLAND ME
04101-4574
US

IV. Provider business mailing address

PO BOX 8484
PORTLAND ME
04104-8484
US

V. Phone/Fax

Practice location:
  • Phone: 207-400-7689
  • Fax: 207-300-6085
Mailing address:
  • Phone: 207-400-7689
  • Fax: 207-300-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC8571
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: