MEDICARE: SUSAN LANE MS, LMFT

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	106H00000X	Marriage & Family Therapist	MFT 2121	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841333028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LANE MS, LMFT

Provider Business Mailing Address
First Line	:	2630 HARRISON AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4441
Country	:	US
Telephone Number	:	407-492-6433
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 N WYMORE RD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2808
Country	:	US
Telephone Number	:	407-975-2565
Fax Number	:

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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