MEDICARE: CIERRA LANE MA, BCBA

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1891421103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIERRA LANE MA, BCBA

Provider Business Mailing Address
First Line	:	4620 N STATE ROAD 7 STE 300
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5867
Country	:	US
Telephone Number	:	561-323-6593
Fax Number	:

Provider Business Practice Location Address
First Line	:	5085 W PARK BLVD STE 500
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-2591
Country	:	US
Telephone Number	:	561-323-6593
Fax Number	:

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

Provider Enumeration Date	:	07/28/2022
Last Update Date	:	03/07/2025

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