Provider Demographics
NPI:1144074147
Name:LANE, MICHAEL (LMSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LANE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 PARK AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2733
Mailing Address - Country:US
Mailing Address - Phone:516-446-1662
Mailing Address - Fax:
Practice Address - Street 1:5020 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-7919
Practice Address - Country:US
Practice Address - Phone:914-734-5248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117254-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker