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General NPI Number Information
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NPI Number | 1144074147
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Entity Type | Individual
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Provider Name | MICHAEL LANE LMSW
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Gender | Male
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Dates
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Enumeration Date | 04/16/2024
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 5020 ROUTE 9W
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City | NEWBURGH
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State | NY
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Zip | 12550-7919
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Country | US
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Telephone | 914-734-5248
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Fax |
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Provider Business Mailing Address
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Address Line | 194 PARK AVE APT 2B
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City | AMITYVILLE
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State | NY
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Zip | 11701-2733
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Country | US
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Telephone | 516-446-1662
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 117254-01
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License Number State | NY
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