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General NPI Number Information
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NPI Number | 1215743851
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Entity Type | Individual
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Provider Name | CHARLES J LANE
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Gender | Male
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 1 MEETING HOUSE RD STE 11
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City | CHELMSFORD
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State | MA
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Zip | 01824-2737
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Country | US
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Telephone | 978-485-4722
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Fax |
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Provider Business Mailing Address
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Address Line | 37 SNOW ST APT 2
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City | BRIGHTON
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State | MA
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Zip | 02135-3412
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Country | US
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Telephone | 857-210-4072
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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 | 228640
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License Number State | MA
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