MEDICARE: LEEANN LANE LCSW

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	0904001911	VA

General Provider Information

NPI Number	:	1205910908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEEANN LANE LCSW

Provider Business Mailing Address
First Line	:	5511 STAPLES MILL RD
Second Line	:	SUITE 102
City	:	RICHMOND
State	:	VA
Zip	:	23228-5445
Country	:	US
Telephone Number	:	804-864-1320
Fax Number	:	804-864-1323

Provider Business Practice Location Address
First Line	:	3111 N PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23294-4408
Country	:	US
Telephone Number	:	804-270-7056
Fax Number	:	804-270-7057

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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