MEDICARE: LANE CASSIDY TESSENEER LCSWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1003399114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANE CASSIDY TESSENEER LCSWA

Provider Business Mailing Address
First Line	:	200 E 2ND AVE
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4358
Country	:	US
Telephone Number	:	704-874-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 EARL RD
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-6700
Country	:	US
Telephone Number	:	704-284-7008
Fax Number	:	704-751-3001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2018
Last Update Date	:	12/08/2025

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