Provider Demographics
NPI:1861745440
Name:LANE, KELLY BEAKLEY (PSYD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:BEAKLEY
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 1:111 N WEST ST STE H
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2760
Mailing Address - Country:US
Mailing Address - Phone:410-443-5527
Mailing Address - Fax:
Practice Address - Street 1:111 N WEST ST STE H
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2760
Practice Address - Country:US
Practice Address - Phone:410-443-5527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05234103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical