MEDICARE: CARINA ELIZABETH LANE

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	104100000X	Social Worker	33013186A	IN
2	222Q00000X	Developmental Therapist		IL
3	104100000X	Social Worker	150.117138	IL

General Provider Information

NPI Number	:	1144848920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARINA ELIZABETH LANE

Provider Business Mailing Address
First Line	:	7951 CALUMET AVE # 1155
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-1215
Country	:	US
Telephone Number	:	773-312-3877
Fax Number	:

Provider Business Practice Location Address
First Line	:	3009 98TH ST
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-3343
Country	:	US
Telephone Number	:	773-954-6900
Fax Number	:

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

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	08/14/2025

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Directions to “ CARINA ELIZABETH LANE ” Practice Location

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