Healthcare Provider Details

I. General information

NPI: 1942756770
Provider Name (Legal Business Name): LANE CHAZDON LCAT, MME, MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 ALBANY POST RD
MONTROSE NY
10548-1454
US

IV. Provider business mailing address

PO BOX 100
MONTROSE NY
10548
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax:
Mailing address:
  • Phone: 914-737-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number0000462-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: