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General NPI Number Information
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NPI Number | 1831900042
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Entity Type | Individual
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Provider Name | ADAM LANE LMSW
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Gender | Male
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 320 POMFRET ST
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City | PUTNAM
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State | CT
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Zip | 06260-1869
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Country | US
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Telephone | 860-963-6385
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Fax | 860-963-6034
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Provider Business Mailing Address
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Address Line | 189 GOSHEN RD
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City | MOOSUP
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State | CT
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Zip | 06354-2012
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Country | US
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Telephone | 860-450-6500
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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 | 10717
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License Number State | CT
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