Provider Demographics
NPI:1063163970
Name:LANE, MAUREEN E (LMHC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:LANE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:ELLEN
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:20 GREAT HILL RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1513
Mailing Address - Country:US
Mailing Address - Phone:508-284-2389
Mailing Address - Fax:
Practice Address - Street 1:20 GREAT HILL RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1513
Practice Address - Country:US
Practice Address - Phone:508-284-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10002133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health