Provider Demographics
NPI:1700912078
Name:LANE, ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 GORSUCH GARTH
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2420
Mailing Address - Country:US
Mailing Address - Phone:301-346-9941
Mailing Address - Fax:410-638-2840
Practice Address - Street 1:25 WEST COURTLAND STREET
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2420
Practice Address - Country:US
Practice Address - Phone:301-346-9941
Practice Address - Fax:410-638-2840
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical