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General NPI Number Information
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NPI Number | 1104058569
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Entity Type | Individual
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Provider Name | ALEXANDER BAILEY LANE LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/19/2009
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 2033 E EDGEWOOD DR STE 4
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City | LAKELAND
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State | FL
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Zip | 33803-3660
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Country | US
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Telephone | 638-606-8097
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Fax |
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Provider Business Mailing Address
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Address Line | 620 W SHADY LN
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City | LAKELAND
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State | FL
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Zip | 33803-2052
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Country | US
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Telephone | 207-347-9904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW14232
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License Number State | FL
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