Healthcare Provider Details

I. General information

NPI: 1407775950
Provider Name (Legal Business Name): ELIZABETH LANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21960 CRESTED QUAIL DR
BROADLANDS VA
20148-7126
US

IV. Provider business mailing address

21960 CRESTED QUAIL DR
BROADLANDS VA
20148-7126
US

V. Phone/Fax

Practice location:
  • Phone: 301-760-8410
  • Fax:
Mailing address:
  • Phone: 301-760-8410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0024198025
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: