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NPI Code Detail

MEDICARE: MRS. JENNIFER ERIN LANE LCSW

MEDICARE: MRS. JENNIFER ERIN 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
11041C0700XClinical Social WorkerLCS 23507CA

General Provider Information

NPI Number : 1376674085
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER ERIN LANE LCSW
Provider Business Mailing Address
First Line : 29520 KEVIN WAY
Second Line :
City : SANTA CLARITA
State : CA
Zip : 91387-7104
Country : US
Telephone Number : 310-592-3773
Fax Number :
Provider Business Practice Location Address
First Line : 43520 DIVISION ST
Second Line :
City : LANCASTER
State : CA
Zip : 93535-4089
Country : US
Telephone Number : 661-266-4783
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 11/11/2020

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