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NPI Code Detail

MEDICARE: CYNTHIA JEFFERSON LANE LMSW, SSW

MEDICARE: CYNTHIA JEFFERSON LANE LMSW, SSW
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
11041C0700XClinical Social Worker6801086730MI

General Provider Information

NPI Number : 1053268789
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYNTHIA JEFFERSON LANE LMSW, SSW
Provider Business Mailing Address
First Line : 2944 MARLBOROUGH ST
Second Line :
City : DETROIT
State : MI
Zip : 48215-2592
Country : US
Telephone Number : 313-303-0602
Fax Number : 313-731-0610
Provider Business Practice Location Address
First Line : 2944 MARLBOROUGH ST
Second Line :
City : DETROIT
State : MI
Zip : 48215-2592
Country : US
Telephone Number : 313-303-0602
Fax Number : 313-731-0610
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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